Bastek Jamie A, Brown Amy G, Foreman Markley N, McShea Meghan A, Anglim Laura M, Adamczak Joanna E, Elovitz Michal A
Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Maternal and Child Health Research Program, Philadelphia, PA 19104, USA.
J Matern Fetal Neonatal Med. 2012 Sep;25(9):1762-8. doi: 10.3109/14767058.2012.663825. Epub 2012 Apr 3.
Our primary objective was to determine whether there was an association between levels of antenatal maternal serum soluble RAGE (sRAGE), drawn at the time of presentation with preterm labor (PTL), and subsequent preterm birth (PTB). Secondary objectives were to determine whether levels of sRAGE - analyzed from both antenatal maternal serum (MS) and postpartum umbilical cord serum (CS) - were associated with neonatal sepsis.
Nested case-control analyses were performed within a prospective cohort of patients at risk for PTB. MS was obtained at enrollment and CS at delivery. The sRAGE levels were analyzed. Non-parametric calculations and receiver-operator analyses were performed.
Overall, 39.8% of patients delivered < 37 weeks (n=498) and 15% had neonatal sepsis (n=193). In comparing cases and controls, sRAGE was significantly lower in those with than those without an adverse event (PTB: median MS-sRAGE 771.79 versus 948.485 pg/mL, p=0.004; neonatal sepsis: 25-centile CS-sRAGE 1220.49 versus 2244.41 pg/mL, p=0.0013). Adding MS-sRAGE to models of clinical variables significantly enhanced the ability of the model to predict both PTB (area under the curve [AUC] 0.71 versus 0.79, p=0.004) and neonatal sepsis (AUC 0.65 versus 0.75, p=0.04). The negative predictive value of CS-sRAGE for neonatal sepsis was very strong (NPV=0.91).
The sRAGE can be used to help predict adverse perinatal outcomes. Patients with higher levels of sRAGE - who therefore may have an enhanced capability to regulate their immune response - appear less likely to experience PTB and neonatal sepsis.
我们的主要目的是确定在早产（PTL）就诊时采集的产前母体血清可溶性晚期糖基化终末产物受体（sRAGE）水平与随后的早产（PTB）之间是否存在关联。次要目的是确定从产前母体血清（MS）和产后脐带血清（CS）中分析的sRAGE水平是否与新生儿败血症有关。
在一个有PTB风险的前瞻性队列患者中进行巢式病例对照分析。在入组时采集MS，在分娩时采集CS。分析sRAGE水平。进行非参数计算和受试者操作分析。
总体而言，39.8%的患者在孕37周前分娩（n = 498），15%的患者发生新生儿败血症（n = 193）。在比较病例组和对照组时，发生不良事件的患者的sRAGE显著低于未发生不良事件的患者（PTB：MS - sRAGE中位数771.79 vs 948.485 pg/mL，p = 0.004；新生儿败血症：CS - sRAGE第25百分位数1220.49 vs 2244.41 pg/mL，p = 0.0013）。将MS - sRAGE添加到临床变量模型中显著增强了模型预测PTB（曲线下面积[AUC] 0.7 vs 0.79，p = 0.004）和新生儿败血症（AUC 0.65 vs 0.75，p = 0.04）的能力。CS - sRAGE对新生儿败血症的阴性预测值非常强（NPV = 0.91）。
sRAGE可用于帮助预测围产期不良结局。sRAGE水平较高的患者——因此可能具有更强的调节免疫反应的能力——似乎不太可能发生PTB和新生儿败血症。
