Department of Obstetrics and Gynecology, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
Ultrasound Obstet Gynecol. 2012 Oct;40(4):398-405. doi: 10.1002/uog.11205.
To evaluate the performance of mean arterial pressure, uterine artery pulsatility index and soluble endoglin level alone or in combination in screening for hypertensive disorders in pregnant women without a-priori high risk.
This was a nested case-control study of women with singleton pregnancies without a-priori high risk who developed pregnancy-induced hypertensive complications. Women were enrolled into the study at 11-14 weeks' gestation, when mean arterial pressure and uterine artery pulsatility index were recorded and a blood sample was taken for measurement of soluble endoglin. Women were followed up in the clinic to detect development of any hypertensive disorder. Each affected case was matched with two normotensive control women with uncomplicated pregnancies that resulted in phenotypically normal infants. Mean values for each variable were compared between cases and controls. Sensitivities, positive predictive values and negative predictive values at fixed specificity were derived from receiver-operating characteristics (ROC) curves.
During the study period, 2120 patients were examined. Of these, 170 (8.02%) were excluded because they were lost to follow-up and in 52 (2.45%) there was fetal death or miscarriage before 24 weeks' gestation. Thus, 1898 cases formed the cohort population. Of these, 89 (4.69%) patients developed complications (study group), including 16 (0.84%) cases with early pre-eclampsia (PE), 60 (3.16%) with late PE and 13 (0.68%) with gestational hypertension (GH). There were 49 (2.58%) cases of spontaneous preterm delivery before 34 weeks. The rest of the cohort population (1760 (92.73%) patients, the base cohort) were not affected by PE or GH. The control group comprised 178 patients. The best model for the prediction of any of the types of hypertensive disorders was one that combined mean arterial pressure with soluble endoglin (area under the ROC curve (AUC), 0.83). The predictive value of the three combined markers was highest for screening for early and late PE (AUC, 0.86 and 0.83, respectively). When each marker was considered alone, the highest prediction of any type of hypertensive disorder was achieved by mean arterial pressure (AUC, 0.73). Sensitivity was lowest for detection of GH when screening both by individual and by combined markers.
First-trimester screening can be useful in predicting women at high risk of developing hypertensive disorders of pregnancy but more prospective longitudinal studies are needed.
评估平均动脉压、子宫动脉搏动指数和可溶性内皮因子水平单独或联合用于筛查无预先高危因素的孕妇的高血压疾病的性能。
这是一项巢式病例对照研究，纳入了无预先高危因素但发生妊娠高血压并发症的单胎妊娠孕妇。孕妇在 11-14 周妊娠时接受平均动脉压和子宫动脉搏动指数记录，并采集血样测量可溶性内皮因子。孕妇在诊所随访以检测任何高血压疾病的发生。每个受影响的病例与 2 个无并发症妊娠的正常血压对照妇女匹配，这些对照妇女的婴儿表型正常。比较病例和对照组的各变量的平均值。通过接受者操作特征（ROC）曲线得出固定特异性的敏感性、阳性预测值和阴性预测值。
在研究期间，共检查了 2120 例患者。其中，170 例（8.02%）因失访而被排除，52 例（2.45%）在 24 周前发生胎儿死亡或流产。因此，1898 例病例构成了队列人群。其中，89 例（4.69%）患者发生并发症（研究组），包括 16 例（0.84%）早发性子痫前期（PE）、60 例（3.16%）晚发性 PE 和 13 例（0.68%）妊娠期高血压（GH）。有 49 例（2.58%）患者在 34 周前发生自发性早产。队列人群的其余部分（1760 例（92.73%）患者，基础队列）未受 PE 或 GH 影响。对照组包括 178 例患者。预测任何类型的高血压疾病的最佳模型是结合平均动脉压和可溶性内皮因子的模型（ROC 曲线下面积（AUC），0.83）。这三个联合标志物的预测值对早发性和晚发性 PE 的筛查最高（AUC，分别为 0.86 和 0.83）。当单独考虑每个标志物时，平均动脉压对任何类型的高血压疾病的预测最高（AUC，0.73）。当通过单独和联合标志物进行筛查时，GH 的检测灵敏度最低。
在预测有发生妊娠高血压疾病风险的妇女方面，早期筛查可能是有用的，但需要更多的前瞻性纵向研究。
