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Abstract：
BACKGROUND: Platelets are pivotal players in the pathophysiology of pre-eclampsia, with observed lower counts in affected individuals compared to normotensive counterparts. Despite advancements, the elusive cause of pre-eclampsia persists, motivating intense global efforts to identify reliable predictors. The currently recommended predictors of pre-eclampsia are not readily available in many resource-limited regions like Nigeria. This cohort study explores the potential of mean platelet volume (MPV) and platelet distribution width (PDW) as predictive markers of early-onset pre-eclampsia. Both platelet indices are components of the full blood count, a widely available routine test in pregnancy.
METHODS: In this prospective cohort study, 648 healthy pregnant women attending antenatal care at Lagos State University Teaching Hospital and General Hospital Ifako-Ijaiye, Lagos, were recruited between 14-18weeks gestational age. Platelet count (PC), MPV and PDW were measured from their venous blood at recruitment. Participants were monitored until 34weeks of gestation, focusing on the occurrence of early-onset preeclampsia as the outcome of interest. Individuals with chronic medical conditions were excluded from the study. Data analysis involved t-test, Chi-Square and Mann-Whitney U tests, with statistical significance set at a confidence level of 95% and p < 0.05. Sensitivity, specificity, and predictive values were determined using receiver operating characteristics (ROC) curves.
RESULTS: The incidence of early-onset pre-eclampsia in the study was 5.9%. Women who later developed pre-eclampsia had higher median MPV and PDW at 14-18weeks (10.8 fl. and 24.8 fl.) compared to normotensive women (8.1 fl. and 13.3 fl.)(p < 0.001). The median PC was lower in pre-eclamptics (190 × 103/µl) compared to normotensives(264 × 103/µl)(p < 0.001). Using Youden\'s test, cut-off values identified: PC < 211.5 × 103/µl, MPV > 9.4 fl., and PDW > 21.3 fl., predicted early-onset pre-eclampsia with 96.6% sensitivity and 65.6% specificity for PC; 79.3% sensitivity and 97.7% specificity for PDW; and 82.8% sensitivity and 96.1% specificity for MPV. Cut-offs of PC < 185 × 103/µl, MPV > 10.7 fl., and PDW > 28.3 fl., predicted severe early-onset pre-eclampsia with 100.0% sensitivity and 90.9% specificity for PC, 100.0% sensitivity and 99.4% specificity for MPV, and 100.0% sensitivity and 99.8% specificity for PDW, with corresponding area under the ROC curves of 0.983, 0.996, and 0.998, respectively.
CONCLUSIONS: The evaluation of MPV and PDW between 14 and 18 weeks of gestation appears to be a reliable predictor of severe early-onset pre-eclampsia.
METHODS: In this prospective cohort study, 648 healthy pregnant women attending antenatal care at Lagos State University Teaching Hospital and General Hospital Ifako-Ijaiye, Lagos, were recruited between 14-18weeks gestational age. Platelet count (PC), MPV and PDW were measured from their venous blood at recruitment. Participants were monitored until 34weeks of gestation, focusing on the occurrence of early-onset preeclampsia as the outcome of interest. Individuals with chronic medical conditions were excluded from the study. Data analysis involved t-test, Chi-Square and Mann-Whitney U tests, with statistical significance set at a confidence level of 95% and p < 0.05. Sensitivity, specificity, and predictive values were determined using receiver operating characteristics (ROC) curves.
RESULTS: The incidence of early-onset pre-eclampsia in the study was 5.9%. Women who later developed pre-eclampsia had higher median MPV and PDW at 14-18weeks (10.8 fl. and 24.8 fl.) compared to normotensive women (8.1 fl. and 13.3 fl.)(p < 0.001). The median PC was lower in pre-eclamptics (190 × 103/µl) compared to normotensives(264 × 103/µl)(p < 0.001). Using Youden\'s test, cut-off values identified: PC < 211.5 × 103/µl, MPV > 9.4 fl., and PDW > 21.3 fl., predicted early-onset pre-eclampsia with 96.6% sensitivity and 65.6% specificity for PC; 79.3% sensitivity and 97.7% specificity for PDW; and 82.8% sensitivity and 96.1% specificity for MPV. Cut-offs of PC < 185 × 103/µl, MPV > 10.7 fl., and PDW > 28.3 fl., predicted severe early-onset pre-eclampsia with 100.0% sensitivity and 90.9% specificity for PC, 100.0% sensitivity and 99.4% specificity for MPV, and 100.0% sensitivity and 99.8% specificity for PDW, with corresponding area under the ROC curves of 0.983, 0.996, and 0.998, respectively.
CONCLUSIONS: The evaluation of MPV and PDW between 14 and 18 weeks of gestation appears to be a reliable predictor of severe early-onset pre-eclampsia.
摘要：
背景：血小板在先兆子痫的病理生理学中起关键作用，与血压正常的个体相比，受影响的个体中观察到的计数较低。尽管取得了进步，先兆子痫的难以捉摸的原因仍然存在，激励全球努力确定可靠的预测因素。目前推荐的先兆子痫预测因子在许多资源有限的地区如尼日利亚不容易获得。这项队列研究探讨了平均血小板体积（MPV）和血小板分布宽度（PDW）作为早发型先兆子痫的预测指标的潜力。两种血小板指数都是全血计数的组成部分，在怀孕期间广泛使用的常规测试。
方法：在这项前瞻性队列研究中，648名健康孕妇在拉各斯州立大学教学医院和Ifako-Ijaiye综合医院接受产前护理，拉各斯,在14-18周胎龄之间招募。血小板计数（PC），在招募时从其静脉血中测量MPV和PDW。参与者被监测到妊娠34周，关注早发型先兆子痫的发生作为关注的结果。患有慢性病的个体被排除在研究之外。数据分析涉及t检验，卡方和曼-惠特尼U检验，具有统计学意义，置信水平为95%，p<0.05。灵敏度,特异性，和预测值使用受试者工作特征(ROC)曲线确定。
结果：研究中早发型先兆子痫的发生率为5.9%。后来发展为先兆子痫的女性在14-18周时的MPV和PDW中位数较高（10.8fl。和24.8fl。）与血压正常的女性（8.1fl。和13.3fl.)(p<0.001)。先兆子痫患者的PC中位数（190×103/µl）低于正常值（264×103/µl）（p<0.001）。使用Youden\的测试，确定的截止值：PC<211.5×103/µl，MPV>9.4fl。,PDW>21.3fl。,预测早发型先兆子痫,对PC的敏感性为96.6%,特异性为65.6%;对PDW的敏感性为79.3%,特异性为97.7%;对MPV的敏感性为82.8%,特异性为96.1%.PC的截止值<185×103/μl,MPV>10.7fl。,PDW>28.3fl。,预测严重的早发型先兆子痫，对PC的敏感性为100.0%，特异性为90.9%，对MPV的100.0%敏感性和99.4%特异性，对PDW的敏感性为100.0%，特异性为99.8%，ROC曲线下的相应面积分别为0.983、0.996和0.998。
结论：在妊娠14至18周之间评估MPV和PDW似乎是重度早发型先兆子痫的可靠预测指标。
方法：在这项前瞻性队列研究中，648名健康孕妇在拉各斯州立大学教学医院和Ifako-Ijaiye综合医院接受产前护理，拉各斯,在14-18周胎龄之间招募。血小板计数（PC），在招募时从其静脉血中测量MPV和PDW。参与者被监测到妊娠34周，关注早发型先兆子痫的发生作为关注的结果。患有慢性病的个体被排除在研究之外。数据分析涉及t检验，卡方和曼-惠特尼U检验，具有统计学意义，置信水平为95%，p<0.05。灵敏度,特异性，和预测值使用受试者工作特征(ROC)曲线确定。
结果：研究中早发型先兆子痫的发生率为5.9%。后来发展为先兆子痫的女性在14-18周时的MPV和PDW中位数较高（10.8fl。和24.8fl。）与血压正常的女性（8.1fl。和13.3fl.)(p<0.001)。先兆子痫患者的PC中位数（190×103/µl）低于正常值（264×103/µl）（p<0.001）。使用Youden\的测试，确定的截止值：PC<211.5×103/µl，MPV>9.4fl。,PDW>21.3fl。,预测早发型先兆子痫,对PC的敏感性为96.6%,特异性为65.6%;对PDW的敏感性为79.3%,特异性为97.7%;对MPV的敏感性为82.8%,特异性为96.1%.PC的截止值<185×103/μl,MPV>10.7fl。,PDW>28.3fl。,预测严重的早发型先兆子痫，对PC的敏感性为100.0%，特异性为90.9%，对MPV的100.0%敏感性和99.4%特异性，对PDW的敏感性为100.0%，特异性为99.8%，ROC曲线下的相应面积分别为0.983、0.996和0.998。
结论：在妊娠14至18周之间评估MPV和PDW似乎是重度早发型先兆子痫的可靠预测指标。
