Polliotti Bruno M, Fry A Gordon, Saller Devereux N, Mooney Robert A, Cox Christopher, Miller Richard K
Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York 11713, USA.
Obstet Gynecol. 2003 Jun;101(6):1266-74. doi: 10.1016/s0029-7844(03)00338-7.
To determine whether alterations in second-trimester maternal serum cytokine concentrations can identify women at risk for developing severe, early-onset preeclampsia.
Patients with severe preeclampsia requiring delivery prior to 34 weeks (n = 20) were each matched by gestational age, gravidity, parity, and sample freezing time with three healthy controls who delivered at term (n = 60). By using second-trimester maternal sera originally collected for fetal aneuploidy screening, the concentrations of placental growth factor, vascular endothelial growth factor, granulocyte colony-stimulating factor, endothelin-1, and human chorionic gonadotropin were compared between patients and controls. Logistic regression analysis was used to estimate odds ratios for high versus low (median split) cytokine concentrations with respect to the development of severe, early-onset preeclampsia. Receiver operating characteristic (ROC) curves based on a second logistic regression, using actual cytokine values, were plotted to illustrate reciprocal impact on sensitivity and specificity.
Placental growth factor and vascular endothelial growth factor levels were significantly lower in patients than in controls. No significant differences were observed for the other cytokines. The odds ratios (with 95% confidence intervals) were 15.54 (3.29, 73.40) for vascular endothelial growth factor and 4.20 (1.35, 13.06) for placental growth factor. Receiver operating characteristic analysis of placental growth factor and vascular endothelial growth factor confirmed that both were useful in discriminating between patients and controls. Models combining both vascular endothelial growth factor and placental growth factor provided the best performance for identifying patients at risk for developing severe, early-onset preeclampsia, according to both odds ratios and ROC analyses.
Combined analysis of placental growth factor and vascular endothelial growth factor is potentially useful as a tool for early identification of patients at risk for developing severe, early-onset preeclampsia.
确定孕中期孕妇血清细胞因子浓度的改变是否能够识别有发生严重早发型子痫前期风险的女性。
将在34周前需要分娩的重度子痫前期患者（n = 20），按照孕周、妊娠次数、产次和样本冷冻时间，与3名足月分娩的健康对照者（n = 60）进行匹配。通过使用最初为胎儿非整倍体筛查而采集的孕中期孕妇血清，比较患者和对照者胎盘生长因子、血管内皮生长因子、粒细胞集落刺激因子、内皮素-1和人绒毛膜促性腺激素的浓度。采用逻辑回归分析估计细胞因子高浓度与低浓度（中位数分割）相对于严重早发型子痫前期发生的比值比。基于第二次逻辑回归，使用实际细胞因子值绘制受试者工作特征（ROC）曲线，以说明对敏感性和特异性的相互影响。
患者的胎盘生长因子和血管内皮生长因子水平显著低于对照者。其他细胞因子未观察到显著差异。血管内皮生长因子的比值比（95%置信区间）为15.54（3.29，73.40），胎盘生长因子为4.20（1.35，13.06）。胎盘生长因子和血管内皮生长因子的受试者工作特征分析证实，两者均有助于区分患者和对照者。根据比值比和ROC分析，联合血管内皮生长因子和胎盘生长因子的模型在识别有发生严重早发型子痫前期风险的患者方面表现最佳。
胎盘生长因子和血管内皮生长因子的联合分析可能作为早期识别有发生严重早发型子痫前期风险患者的工具。
