妊娠早期平均血小板体积对子痫前期的预测价值：一项荟萃分析。
完整摘要 · 中文译文
引言：子痫前期是一种妊娠期高血压疾病，全球3-7%的妊娠受其影响，并且是全球孕产妇死亡的主要原因之一。早期预测对于改善母婴结局至关重要，但仍是一项重大挑战。妊娠期间，激素和免疫学变化形成高凝、促炎状态，导致内皮损伤、血小板消耗增加以及较大、新产生和活化血小板的释放，从而导致平均血小板体积（MPV）升高。 材料与方法：本荟萃分析旨在量化早孕期测量的MPV与随后发生子痫前期之间的关联，并区分其亚型。在五个数据库（即PubMed、Cochrane Library、Scopus、Embase和Web of Science）中进行了系统检索，截至2025年7月。该研究在PROSPERO注册（CRD420251091010）。符合条件的研究包括妊娠20周前测量MPV、随后被诊断患有或不患有子痫前期的孕妇数据。数据提取后，采用随机效应（网络）荟萃分析模型计算发生子痫前期女性与血压正常对照之间MPV的合并均数差（MD）和均值比（ROM）。按早发型与晚发型以及重度与轻度子痫前期进行亚组分析。 结果：共纳入20项研究，涉及3050例子痫前期患者和12 522例血压正常对照。随后发生子痫前期的女性——无论 其子痫前期亚组——在妊娠早期（妊娠20周前）与对照组相比具有更高的平均血小板体积（MPV）值，合并平均差（MD）和平均比值（ROM）分别为+0.5681 fL［95%置信区间（CI）：+0.2144至+0.9217；p=0.0016］和105.83%（95%CI：102.11-109.69%；p=0.0019）。亚组分析表明，疾病越严重，关联越强，与各自对照组相比，早发型子痫前期（MD=+0.6943 fL，95%CI：-0.2361至+1.6246，p=0.1436；ROM：107.44%；p=0.1684）和重度子痫前期（MD=+0.4201 fL，95%CI：+0.1210至+0.7192，p=0.0059；ROM：104.26%；p=0.0064）中观察到更大的MD。 结论：妊娠早期MPV升高与发生子痫前期的风险增加相关，尤其是其重度和早发型。
完整摘要 · 英文原文
INTRODUCTION: Preeclampsia is a hypertensive disorder of pregnancy that affects 3-7% of pregnancies globally and is a leading cause of maternal mortality worldwide. Early prediction is crucial for improving maternal and fetal outcomes, but it remains a significant challenge. During pregnancy, hormonal and immunological changes create a hypercoagulable, pro-inflammatory state that leads to endothelial injury, increased platelet consumption, and the release of larger, newly produced and activated platelets, resulting in elevated mean platelet volume (MPV). MATERIAL AND METHODS: This meta-analysis aimed to quantify the association between MPV measured in early pregnancy and the subsequent development of preeclampsia, differentiating between its subtypes. A systematic search was conducted in five databases, namely: PubMed, Cochrane Library, Scopus, Embase, and Web of Science up to July 2025. The study was registered in PROSPERO (CRD420251091010). Eligible studies included data on MPV measurements in pregnant women before 20 weeks of gestation who were later diagnosed with or without preeclampsia. Following data extraction, random effects (network) meta-analysis models were performed to calculate the pooled mean difference (MD) and ratio of means (ROM) in MPV between women who developed preeclampsia and normotensive controls. Subgroup analyses were performed for early-onset vs. late-onset and severe vs. mild preeclampsia. RESULTS: Twenty studies involving 3050 preeclamptic patients and 12 522 normotensive controls were included. Women who later developed preeclampsia-irrespective of their preeclampsia subgroups-had higher MPV values in early pregnancy (before 20 weeks of gestation) compared to controls, with a pooled MD and ROM of +0.5681 fL [95% confidence interval (CI): +0.2144 to +0.9217; p = 0.0016] and 105.83% (95% CI: 102.11-109.69%; p = 0.0019), respectively. Subgroup analyses indicated a stronger association in more severe forms of the disease, with a greater MD observed in early-onset preeclampsia (MD = +0.6943 fL, 95% CI: -0.2361 to +1.6246, p = 0.1436; ROM: 107.44%; p = 0.1684) and severe preeclampsia (MD = +0.4201 fL, 95% CI: +0.1210 to +0.7192, p = 0.0059; ROM: 104.26%; p = 0.0064) compared to their controls. CONCLUSION: Elevated MPV in early pregnancy is associated with an increased risk of developing preeclampsia, particularly its severe and early-onset forms.