Papageorghiou Aris T, Campbell Stuart
St George's, University of London, London, UK.
Curr Opin Obstet Gynecol. 2006 Dec;18(6):594-600. doi: 10.1097/GCO.0b013e328010beda.
Aspirin therapy from the first trimester of pregnancy may benefit women at high risk for preeclampsia. We review publications from the past year that examine first-trimester screening studies for preeclampsia.
For a false positive rate of 5%, first-trimester uterine artery Doppler studies will detect 50-65% of women who will develop severe preeclampsia (i.e. needing delivery before 35 weeks). Measurement of placental volume with three-dimensional ultrasound at 11-14 weeks detected 20% for a false positive rate of 10% in one study and further evaluation of this technique is needed. Maternal serum placental growth factor, vascular endothelial growth factor and soluble fms-like tyrosine kinase-1 have shown initial promise, but recent studies have shown no improvement in screening compared with using uterine artery Doppler alone. Placental protein 13 is the most promising serum marker and in combination with uterine Doppler may predict up to 90% of cases of severe preeclampsia for a false positive rate of 9%.
First-trimester uterine artery Doppler can identify over half of women who will develop preeclampsia. Detection rates may be increased by a combination of uterine artery Doppler with first-trimester maternal serum markers, especially placental protein 13. Such high-risk women may be the most likely to benefit from pharmacological intervention in future trials.
妊娠早期使用阿司匹林治疗可能使患先兆子痫风险高的女性受益。我们回顾过去一年中有关妊娠早期先兆子痫筛查研究的出版物。
对于5%的假阳性率，妊娠早期子宫动脉多普勒研究可检测出50 - 65%将发生严重先兆子痫（即需在35周前分娩）的女性。一项研究中，在孕11 - 14周用三维超声测量胎盘体积，假阳性率为10%时可检测出20%的病例，该技术还需进一步评估。母体血清胎盘生长因子、血管内皮生长因子和可溶性fms样酪氨酸激酶-1已初显成效，但最近的研究表明，与单独使用子宫动脉多普勒相比，筛查并无改善。胎盘蛋白13是最有前景的血清标志物，与子宫多普勒联合使用时，对于9%的假阳性率，可预测高达90%的严重先兆子痫病例。
妊娠早期子宫动脉多普勒可识别超过半数将发生先兆子痫的女性。子宫动脉多普勒与妊娠早期母体血清标志物（尤其是胎盘蛋白13）联合使用可能提高检测率。这类高危女性可能最有可能在未来试验中从药物干预中受益。
