Verghese L, Alam S, Beski S, Thuraisingham R, Barnes I, MacCallum P
Department of Obstetrics and Gynaecology, Royal London Hospital, London, UK.
J Obstet Gynaecol. 2012 Feb;32(2):128-31. doi: 10.3109/01443615.2011.635224.
The NICE and PRECOG guidelines are based on systematic reviews of risk factors for pre-eclampsia to identify mothers at risk before 20 weeks' gestation. Cases (64) and controls (112) were classified retrospectively as screen positive or negative as recommended by the two guidelines The NICE guideline had a higher sensitivity rate of 77% (95% CI 65-87%) vs 59% (95% CI 46-71%) but a lower specificity of 54% (95% CI 44-64%) vs 81% (95% CI 73-88%) with the PRECOG guideline. Based on an incidence of pre-eclampsia of 4% the positive predictive values of PRECOG and NICE guidelines were estimated at only 11% and 7%, respectively. The most discriminatory risk factor was history of pre-eclampsia in a previous pregnancy. Neither guideline has a reasonable performance and cannot be recommended for use in clinical practice. Resources should rather be focussed on development of new strategies to identify women at risk of pre-eclampsia.
英国国家卫生与临床优化研究所（NICE）和PRECOG指南基于对先兆子痫风险因素的系统评价，以识别妊娠20周前有风险的母亲。按照这两项指南的建议，对64例病例和112例对照进行回顾性分类，分为筛查阳性或阴性。NICE指南的灵敏度较高，为77%（95%置信区间65 - 87%），而PRECOG指南为59%（95%置信区间46 - 71%）；但NICE指南的特异度较低，为54%（95%置信区间44 - 64%），而PRECOG指南为81%（95%置信区间73 - 88%）。基于先兆子痫4%的发病率，PRECOG和NICE指南的阳性预测值分别仅估计为11%和7%。最具鉴别力的风险因素是既往妊娠有先兆子痫病史。这两项指南的表现均不合理，不建议在临床实践中使用。资源应更多地集中于开发识别有先兆子痫风险女性的新策略。
