Chaiworapongsa Tinnakorn, Romero Roberto, Korzeniewski Steven J, Cortez Josef M, Pappas Athina, Tarca Adi L, Chaemsaithong Piya, Dong Zhong, Yeo Lami, Hassan Sonia S
Perinatology Research Branch, NICHD/NIH/DHHS , Detroit, MI , USA .
J Matern Fetal Neonatal Med. 2014 Jan;27(2):132-44. doi: 10.3109/14767058.2013.806905. Epub 2013 Aug 8.
To prospectively determine the prognostic value of maternal plasma concentrations of placental growth factor (PlGF), soluble endoglin (sEng) and soluble vascular endothelial growth factor receptors-1 and -2 (sVEGFR-1 and -2) in identifying patients with suspected preeclampsia (PE), who require preterm delivery (PTD) or develop adverse outcomes.
This prospective cohort study included 85 consecutive patients who presented to the obstetrical triage area at 20-36 weeks with a diagnosis of "rule out PE." Patients were classified as: 1) those who remained stable until term (n = 37); and 2) those who developed severe PE and required PTD (n = 48). Plasma concentrations of PlGF, sEng and sVEGFR-1 and -2 were determined by ELISA.
Patients with PlGF/sVEGFR-1 ≤0.05 multiples of the median (MoM) or PlGF/sEng ≤0.07 MoM were more likely to deliver preterm due to PE [adjusted odd ratio (aOR) 7.4 and 8.8], and to develop maternal (aOR 3.7 and 2.4) or neonatal complications (aOR 10.0 and 10.1). Among patients who presented <34 weeks of gestation, PlGF/sVEGFR-1 ≤ 0.035 MoM or PlGF/sEng ≤0.05 MoM had a sensitivity of 89% (16/18), specificity of 96% (24/25) and likelihood ratio for a positive test of 22 to identify patients who delivered within 2 weeks. The addition of the PlGF/sVEGFR-1 ratio to standard clinical tests improved the sensitivity at a fixed false-positive rate of 3% (p = 0.004) for the identification of patients who were delivered due to PE within 2 weeks. Among patients who had a plasma concentration of PlGF/sVEGFR-1 ratio ≤0.035 MoM, 0.036-0.34 MoM and ≥0.35 MoM, the rates of PTD <34 weeks were 94%, 27% and 7%, respectively.
The determination of angiogenic/anti-angiogenic factors has prognostic value in patients presenting to the obstetrical triage area with suspected PE for the identification of those requiring preterm delivery and at risk for adverse maternal/neonatal outcomes.
前瞻性确定母体血浆中胎盘生长因子（PlGF）、可溶性内皮糖蛋白（sEng）以及可溶性血管内皮生长因子受体-1和-2（sVEGFR-1和sVEGFR-2）的浓度对于识别疑似先兆子痫（PE）且需要早产（PTD）或出现不良结局患者的预后价值。
这项前瞻性队列研究纳入了85例连续就诊于产科分诊区的患者，这些患者在孕20 - 36周时被诊断为“排除PE”。患者被分为：1）那些直至足月仍保持稳定的患者（n = 37）；2）那些发展为重度PE并需要PTD的患者（n = 48）。采用酶联免疫吸附测定法（ELISA）测定PlGF、sEng以及sVEGFR-1和sVEGFR-2的血浆浓度。
PlGF/sVEGFR-1≤0.05中位数倍数（MoM）或PlGF/sEng≤0.07 MoM的患者因PE早产的可能性更高[校正比值比（aOR）分别为7.4和8.8]，发生母体（aOR分别为3.7和2.4）或新生儿并发症（aOR分别为10.0和10.1）的可能性也更高。在妊娠<34周就诊的患者中，PlGF/sVEGFR-1≤0.035 MoM或PlGF/sEng≤0.05 MoM识别2周内分娩患者的灵敏度为89%（16/18），特异度为96%（24/25），阳性似然比为22。将PlGF/sVEGFR-1比值加入标准临床检测，在固定假阳性率为3%的情况下，识别2周内因PE分娩患者的灵敏度提高（p = 0.004）。在血浆PlGF/sVEGFR-1比值≤0.035 MoM、0.036 - 0.34 MoM和≥0.35 MoM的患者中，<34周的PTD发生率分别为94%、27%和7%。
对于就诊于产科分诊区的疑似PE患者，测定血管生成/抗血管生成因子对于识别那些需要早产以及有母体/新生儿不良结局风险的患者具有预后价值。
