胎盘生长因子在子痫前期患者中的动态变化及对妊娠结局的预测效能

刘桂莹; 王春梅; 杨宗梅

doi:10.16016/j.2097-0927.202505068

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胎盘生长因子在子痫前期患者中的动态变化及对妊娠结局的预测效能

临床医学 | 更新时间：2025-10-13

- 胎盘生长因子在子痫前期患者中的动态变化及对妊娠结局的预测效能
- Dynamic change in placental growth factor in patients with preeclampsia and its predictive efficay for pregnancy outcomes
- 陆军军医大学学报 2025年47卷第19期页码：2414-2424
- 作者机构：
  
  1.天津市北辰医院：产科，天津
  2.天津市北辰医院：检验科，天津
- 作者简介：
  
  刘桂莹，Email：52160301@qq.com
- 基金信息：
  
  天津市科学技术成果登记证书(津20250147);Corresponding author： LIU Guiying, E-mail： 52160301@qq.com
- DOI：10.16016/j.2097-0927.202505068
  中图分类号： R181.32;R341;R714.245
- 收稿：2025-05-28，
  
  修回：2025-08-20，
  
  录用：2025-09-10，
  
  纸质出版：2025-10-15
- 稿件说明：
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刘桂莹，王春梅，杨宗梅.胎盘生长因子在子痫前期患者中的动态变化及对妊娠结局的预测效能［J］.陆军军医大学学报，2025，47（19）：2414-2424.DOI：10.16016/j.2097-0927.202505068.

LIU G Y，WANG C M，YANG Z M.Dynamic change in placental growth factor in patients with preeclampsia and its predictive efficay for pregnancy outcomes［J］.J Army Med Univ，2025，47（19）：2414-2424.DOI：10.16016/j.2097-0927.202505068.
刘桂莹，王春梅，杨宗梅.胎盘生长因子在子痫前期患者中的动态变化及对妊娠结局的预测效能［J］.陆军军医大学学报，2025，47（19）：2414-2424.DOI：10.16016/j.2097-0927.202505068. DOI：

LIU G Y，WANG C M，YANG Z M.Dynamic change in placental growth factor in patients with preeclampsia and its predictive efficay for pregnancy outcomes［J］.J Army Med Univ，2025，47（19）：2414-2424.DOI：10.16016/j.2097-0927.202505068. DOI：

摘要

目的

分析胎盘生长因子（placental growth factor，PLGF）水平在子痫前期（preeclampsia，PE）患者中的动态改变及对妊娠结局预测作用。

方法

采用回顾性队列研究，选取2021年1月至2024年1月天津市北辰医院产科收治的198例患者，其中非重度PE有151例，重度PE有47例。同期于天津市北辰医院产科另纳入100位健康孕妇为对照组。对198例PE患者依据其妊娠的最终状况进行划分：不良结局组（88例）与良好结局组（110例）。采用局部加权回归散点平滑法（locally weighted scatterplot smoothing，LOWESS）分析血管内皮功能指标与PLGF浓度的关系；采用Logistic回归分析患者发生不良妊娠结局的影响因素；采用受试者操作特征曲线（receiver operating characteristic curve，ROC）分析PLGF浓度对非重度PE、重度PE患者不良妊娠结局的预测价值。

结果

不同孕周PLGF水平呈峰形，孕28~29

周水平较低，随着孕周增加逐渐升高，孕30~31

周达高峰后逐渐下降（

0.05），对照组、非重度PE组、重度PE组PLGF逐渐降低（

0.05）。LOWESS方法分析结果显示，PLGF浓度与可溶性血管内皮生长因子受体-1（soluble fms-like tyrosine kinase receptor1，sFlt-1）、血管内皮生长因子（vascular endothelial growth factor，VEGF）、一氧化氮（nitric oxide，NO）、血栓调节蛋白（thrombomodulin，TM）、血栓素A2（thromboxane A2，TXA2）以及血管假性血友病因子（von willebrand factor，VwF）均具有一定的非线性关系。Logistic回归分析结果显示，逐步排除共线性混杂因素并校正各协变量后，28~29

孕周PLGF水平与妊娠结局仍存在独立相关性（

=0.593，95%

：0.583~0.778，

0.001）；将PLGF水平转化为二分类变量后，PLGF高水平与妊娠结局存在独立相关性（

=0.773，95%

：0.671~0.885，

0.001）；与PLGF最低的五分位数组（Q1）相比，随着PLGF水平逐渐升高（Q2~Q5组），相关性效应值分别为（

=0.765，95%

：0.639~0.837，

=0.092）、（

=0.752，95%

：0.624~0.818，

=0.056）、（

=0.696，95%

：0.615~0.813，

=0.027）、（

=0.642，95%

：0.591~0.733，

0.001），且趋势性检验存在统计学意义（

趋势

0.001）。ROC曲线分析显示，28~29

孕周血清PLGF水平预测非重度PE患者不良妊娠结局的ROC曲线下面积为0.830（95%

：0.635-0.917），最佳临界阈值为75.47 ng/L，敏感度为88.37%，特异度为71.30%

，阳性预测值为55.07%，阴性预测值为93.90%；预测重度PE患者不良妊娠结局的ROC曲线下面积为0.874（95%

：0.677-0.923），最佳临界阈值为38.53 ng/L，敏感度为88.89%，特异度为50.00%，阳性预测值为97.56%，阴性预测值为16.67%。

结论

28~29

孕周PLGF与妊娠结局存在独立相关性且对非重度PE和重度PE患者不良妊娠结局的预测性能良好。

Abstract

Objective

To analyze the dynamic change in placental growth factor (PLGF) level in patients with preeclampsia (PE) and its role in predicting pregnancy outcomes.

Methods

A retrospective cohort study was conducted on 198 PE patients admitted to Department of Obstetrics of Tianjin Beichen Hospital from January 2021 to January 2024. Among them

151 cases were identified as non-severe PE and 47 cases as severe PE. During the same period

another 100 healthy pregnant women were included in the department and served as the control group. According to the final pregnancy status of the PE patients

they were divided into an adverse outcome group (88 cases) and a good outcome group (110 cases). Locally Weighted Scatterplot Smoothing (LOWESS) was used to analyze the relationship between vascular endothelial function indicators and PLGF level. Logistic regression was employed to identify the influencing factors for adverse pregnancy outcomes. Receiver operating characteristic (ROC) curve was plotted to evaluate the value of PLGF level for predicting adverse pregnancy outcomes in patients with non-severe PE and severe PE.

Results

The PLGF level was in a peak shape at different gestational weeks

relatively low at 28~29

weeks of gestation

gradually increasing with the increment of gestational weeks

reaching a peak at 30~31

weeks of gestation

and then gradually decreased (

0.05). The PLGF level was gradually reduced in the control group

non-severe PE group

and severe PE group in turn (

0.05). LOWESS analysis showed that the PLGF level exhibi

ted certain nonlinear relationship with soluble fms-like tyrosine kinase receptor 1 (sFlt-1)

vascular endothelial growth factor (VEGF)

nitric oxide (NO)

thrombomodulin (TM)

thromboxane A2 (TXA2)

and Von Willebrand factor (VwF). The results of logistic regression analysis indicated that after gradually eliminating collinearity confounding factors and adjusting for each covariate

there was still an independent correlation between the PLGF level at 28~29

gestational weeks and pregnancy outcome (

=0.593

95%

: 0.583~0.778

0.001). After converting the PLGF level into a binary variable

there was an independent correlation between high PLGF level and pregnancy outcome (

=0.773

95%

: 0.671~0.885

0.001). Compared with the quintile with the lowest PLGF (Q1)

as the PLGF level gradually increased (Q2 to Q5)

the correlation effect values were (

=0.765

95%

: 0.639~0.837

=0.092)

(

=0.752

95%

: 0.624~0.818

=0.056)

(

=0.696

95%

: 0.615~0.813

=0.027)

and (

=0.642

95%

CI:

0.591~0.733

0.001)

and the trend test was statistically significant (

trend

0.001). ROC curve analysis revealed that the area under the ROC curve (AUC) of serum PLGF level at 28-29

gestational weeks in predicting adverse pregnancy outcomes in non-severe PE patients was 0.830 (95%

: 0.635~0.917)

the optimal critical threshold was 75.47 ng/L

the sensitivity was 88.37%

the specificity was 71.30%

the positive predictive value was 55.07%

and the negative predictive value was 93.90%. Its AUC value of the level for the prediction in patients with severe PE was 0.874 (95%

: 0.677~0.923)

the optimal critical threshold was 3

8.53 ng/L

the sensitivity was 88.89%

the specificity was 50.00%

the positive predictive value was 97.56%

and the negative predictive value was 16.67%.

Conclusion

At 28~29

gestational weeks

PLGF has an independent correlation with pregnancy outcomes and shows a good predictive performance for adverse pregnancy outcomes in patients with non-severe PE and severe PE.

关键词

Keywords

references

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（投稿：2025-05-28 ；修回： 2025-08-20 ）

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