Chavarría María Eugenia, Lara-González Lina, González-Gleason Alejandro, García-Paleta Yolanda, Vital-Reyes Víctor Saúl, Reyes Alejandro
Medical Research Unit in Reproductive Medicine, Luis Castelazo-Ayala Gynecology and Obstetrics Hospital, Mexico City, Mexico.
Am J Obstet Gynecol. 2003 Apr;188(4):986-92. doi: 10.1067/mob.2003.203.
The purpose of this study was to examine 6-keto-prostaglandin F(1)(alpha) and thromboxane B(2) plasma levels throughout normotensive and preeclamptic pregnancies and to analyze the predictive values of these quantifications for the detection of preeclampsia during the second trimester of pregnancy.
Blood samples were collected from 30 healthy, nonpregnant women and at 4-week intervals from a cohort of nulliparous women who were recruited before 16 weeks of gestation. Preeclampsia developed in 26 patients; 52 normotensive control subjects were matched from the same cohort. The 6-keto-prostaglandin F(1)(alpha) and thromboxane B(2) were assayed by radioimmunoassay. Trends were compared between pregnancy groups and with the nonpregnant women. Predictive values were determined with the second-trimester assessments.
The 6-keto-prostaglandin F(1)(alpha)/thromboxane B(2) ratio decreased throughout pregnancy in women with preeclampsia; there were no significant changes in normotensive women. We found higher thromboxane B(2) levels within the group with preeclampsia during the first gestational trimester (preeclampsia, 188 +/- 17 pg/mL; control, 119 +/- 4.8 pg/mL [mean +/- SEM]; P =.001). During the third trimester, patients with preeclampsia had lower 6-keto-prostaglandin F(1)(alpha) levels than did control subjects (preeclampsia, 191 +/- 9.8 pg/mL; control, 288 +/- 10 pg/mL; P =.001). The 6-keto-prostaglandin F(1)(alpha)/thromboxane B(2) ratio was suitable to calculate predictive values; the best cutoff point and time interval were 3.0 and 22 to 26 weeks of gestation, respectively. Sensitivity, specificity, and positive and negative predictive values were 88%, 97%, 69%, and 99%, respectively; the odds ratio was 14.6 (95% CI, 6.9-30.4).
The prostacyclin/thromboxane ratio favored vasoconstriction early in gestation in women in whom preeclampsia developed. A 6-keto-prostaglandin F(1)(alpha)/thromboxane B(2) ratio of <or=3.0 at 22 to 26 weeks of gestation had a high predictive value for the development of preeclampsia.
本研究旨在检测正常血压和子痫前期孕妇整个孕期血浆中6-酮-前列腺素F(1)(α)和血栓素B2的水平，并分析这些定量指标在孕中期检测子痫前期的预测价值。
采集30名健康未孕女性以及一群在妊娠16周前招募的未生育女性每4周一次的血样。26例患者发生子痫前期；从同一队列中匹配52名血压正常的对照者。采用放射免疫分析法检测6-酮-前列腺素F(1)(α)和血栓素B2。比较妊娠组与未孕女性之间的变化趋势，并根据孕中期评估确定预测价值。
子痫前期女性整个孕期6-酮-前列腺素F(1)(α)/血栓素B2比值降低；血压正常女性无显著变化。我们发现子痫前期组在妊娠早期血栓素B2水平较高（子痫前期，188±17 pg/mL；对照组，119±4.8 pg/mL[均值±标准误]；P = 0.001）。在妊娠晚期，子痫前期患者的6-酮-前列腺素F(1)(α)水平低于对照组（子痫前期，191±9.8 pg/mL；对照组，288±10 pg/mL；P = 0.001）。6-酮-前列腺素F(1)(α)/血栓素B2比值适合计算预测价值；最佳截断点和时间间隔分别为3.0以及妊娠22至26周。敏感性、特异性、阳性预测值和阴性预测值分别为88%、97%、69%和99%；比值比为14.6（可信区间95%，6.9 - 30.4）。
前列环素/血栓素比值在子痫前期女性妊娠早期利于血管收缩。妊娠22至26周时6-酮-前列腺素F(1)(α)/血栓素B2比值≤3.0对子痫前期的发生具有较高的预测价值。
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