Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, USA.
BJOG. 2013 May;120(6):681-94. doi: 10.1111/1471-0528.12172. Epub 2013 Feb 11.
Several biomarkers for predicting intrauterine growth restriction (IUGR) have been proposed in recent years. However, the predictive performance of these biomarkers has not been systematically evaluated.
To determine the predictive accuracy of novel biomarkers for IUGR in women with singleton gestations.
Electronic databases, reference list checking and conference proceedings.
Observational studies that evaluated the accuracy of novel biomarkers proposed for predicting IUGR.
Data were extracted on characteristics, quality and predictive accuracy from each study to construct 2×2 tables. Summary receiver operating characteristic curves, sensitivities, specificities and likelihood ratios (LRs) were generated.
A total of 53 studies, including 39,974 women and evaluating 37 novel biomarkers, fulfilled the inclusion criteria. Overall, the predictive accuracy of angiogenic factors for IUGR was minimal (median pooled positive and negative LRs of 1.7, range 1.0-19.8; and 0.8, range 0.0-1.0, respectively). Two small case-control studies reported high predictive values for placental growth factor and angiopoietin-2 only when IUGR was defined as birthweight centile with clinical or pathological evidence of fetal growth restriction. Biomarkers related to endothelial function/oxidative stress, placental protein/hormone, and others such as serum levels of vitamin D, urinary albumin:creatinine ratio, thyroid function tests and metabolomic profile had low predictive accuracy.
None of the novel biomarkers evaluated in this review are sufficiently accurate to recommend their use as predictors of IUGR in routine clinical practice. However, the use of biomarkers in combination with biophysical parameters and maternal characteristics could be more useful and merits further research.
近年来，已经提出了几种预测宫内生长受限（IUGR）的生物标志物。然而，这些生物标志物的预测性能尚未得到系统评估。
确定新型生物标志物在预测单胎妊娠中 IUGR 的准确性。
电子数据库、参考文献检查和会议记录。
评估新型生物标志物预测 IUGR 准确性的观察性研究。
从每项研究中提取特征、质量和预测准确性数据，以构建 2×2 表。生成汇总接收者操作特征曲线、敏感度、特异性和似然比（LR）。
共有 53 项研究，包括 39974 名女性，评估了 37 种新型生物标志物，符合纳入标准。总体而言，血管生成因子预测 IUGR 的准确性较低（中位数汇总阳性和阴性 LR 分别为 1.7，范围为 1.0-19.8；0.8，范围为 0.0-1.0）。两项小病例对照研究报告称，仅当 IUGR 定义为具有临床或病理胎儿生长受限证据的体重百分位时，胎盘生长因子和血管生成素-2 的预测值较高。与内皮功能/氧化应激、胎盘蛋白/激素相关的生物标志物以及其他生物标志物，如血清维生素 D 水平、尿白蛋白：肌酐比、甲状腺功能检查和代谢组学特征，其预测准确性较低。
本综述评估的新型生物标志物均不够准确，不能推荐其用于常规临床实践中预测 IUGR。然而，生物标志物与生物物理参数和母体特征结合使用可能更有用，值得进一步研究。
