ارزش تشخیصی پروتئین پلاسمایی A مرتبط با بارداری و داپلر در زنان با محدودیت رشد داخل رحمی جنین

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استادیار گروه زنان و زایمان، مرکز تحقیقات بالینی بیمارستان امام رضا (ع)، دانشکده پزشکی، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.

2 دانشیار گروه پزشکی اجتماعی، مرکز تحقیقات توسعه اجتماعی و ارتقاء سلامت، دانشکده پزشکی، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.

3 پزشک عمومی، دانشکده پزشکی، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.

10.22038/ijogi.2025.87532.6417

چکیده

مقدمه: محدودیت رشد داخل رحمی (IUGR) با افزایش عوارض و مرگ‌و‌میر حول‌و‌حوش زایمان و همچنین مشکلات رشد در درازمدت همراه است. مطالعه حاضر با هدف بررسی ارزش تشخیصی پروتئین پلاسمایی A مرتبط با بارداری (PAPP-A) در ارزیابی خطر IUGR انجام شد.
روش‌کار: این مطالعه مورد- شاهدی و گذشته‌نگر در سال 1402-1399 بر روی 80 بارداری تک‌قلویی مبتلا به محدودیت رشد داخل رحمی (IUGR) به‌عنوان گروه مورد و 80 بارداری بدون عارضه به‌عنوان گروه کنترل انجام شد. سطح سرمی PAPP-A و β-hCG در سه‌ماهه اول بارداری (هفته 13-11) اندازه‌گیری و به‌صورت مضربی از میانه (MoM) بیان شد. داپلر شریان رحمی از طریق میانگین شاخص ضربانی (PI) ارزیابی شد. از رگرسیون لجستیک و منحنی‌های مشخصه عملکرد گیرنده (ROC) برای تعیین نسبت شانس (OR)، حساسیت‌ و ویژگی ‌استفاده شد. تجزیه‌ و تحلیل داده­ ها با استفاده از نرم‌افزار آماری SPSS (نسخه 27) و آزمون‌های کای دو، دقیق فیشر و تی‌مستقل انجام شد. میزان p کمتر از 05/0 معنادار در نظر گرفته شد.
یافته ها: میانگین سطح PAPA-A در زنان با نوزاد IUGR (37/0±83/0) به‌طور معنی‌داری پایین‌تر از میانگین آن در گروه کنترل (95/0±17/1) (002/0>p) و میانگین PI شریان رحمی در موارد بالاتر (85/1 در مقابل 42/1، 001/0>p) گزارش شد. PI بالا (بیش از صدک 95) IUGR را با نسبت شانس 5/5 (8/9-1/3: 95% CI) و PAPA- A با 52/0 (84/0-34/0: 95% CI) پیش‌بینی کرد.
نتیجه­ گیری: در غربالگری سه ماهه اول علاوه بر ارزیابی خطر سندرم‌ داون، سطح سرمی PAPA-A و داپلر شریان رحمی برای پیش‌بینی خطر IUGR می­ تواند کاربرد داشته باشد.

کلیدواژه‌ها

موضوعات

عنوان مقاله [English]

Diagnostic Value of Pregnancy-Associated Plasma Protein A in Women with Intrauterine Fetal Growth Restriction

نویسندگان [English]

  • Nasrin Mansouri 1
  • Ali Azizi 2
  • Maryam Ayni 3
1 Assistant Professor, Department of Obstetrics and Gynecology, Clinical Research Center of Imam Reza Hospital, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
2 Associate Professor, Department of Community Medicine, Social Development and Health Promotion Research Center, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
3 General Physician, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
چکیده [English]

Introduction: Intrauterine growth restriction (IUGR) is associated with increased perinatal morbidity and mortality as well as long-term growth and health problems. This study was conducted with aim to investigate the diagnostic value of pregnancy-associated plasma protein A (PAPP-A) in assessing the risk of IUGR.
Methods: This retrospective case-control study was conducted from 2020 to 2023 on 80 singleton pregnancies with IUGR as the case group and 80 uncomplicated pregnancies as the control group. Serum PAPP-A and β-hCG levels were measured in the first trimester of gestation (weeks 11–13) and expressed as multiples of the median (MoM). Uterine artery Doppler was assessed by mean pulsatility index (PI). Logistic regression and receiver operating characteristic (ROC) curves were used to determine odds ratio (OR), sensitivity, and specificity. Data analysis was performed using SPSS statistical software (version 27) and Chi-square, Fisher's exact and independent t-tests. P<0.05 was considered significant.
Results: The mean PAPA-A level in women with IUGR infants (0.83±0.37) was significantly lower than that in the control group (1.17±0.95) (P < 0.002) and the mean uterine artery PI was higher (1.85 vs. 1.42, P < 0.001). High PI (>95th percentile) predicted IUGR with an odds ratio of 5.5 (95% CI: 3.1-9.8) and PAPA-A was 0.52 (95% CI: 0.34-0.84).
Conclusion: In first trimester screening, in addition to assessing the risk of Down syndrome, serum PAPA-A levels and uterine artery Doppler can be used to assess the risk of IUGR.

کلیدواژه‌ها [English]

  • Diagnostic Value
  • Intrauterine Growth Restriction
  • Pregnancy
  • Pregnancy-Associated Plasma Protein A
  • Uterine artery Doppler

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مجله زنان، مامایی و نازایی ایران
دوره 28، شماره 8
آبان 1404
صفحه 10-19

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