Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
PLoS One. 2013 May 22;8(5):e63546. doi: 10.1371/journal.pone.0063546. Print 2013.
In a previous study, we have described the predictive value of first-trimester Pregnancy-Associated Plasma Protein-A (PAPP-A), free β-subunit of human Chorionic Gonadotropin (fβ-hCG), Placental Growth Factor (PlGF) and A Disintegrin And Metalloprotease 12 (ADAM12) for early onset preeclampsia (EO-PE; delivery <34 weeks). The objective of the current study was to obtain the predictive value of these serum makers combined with maternal characteristics and first-trimester maternal mean arterial blood pressure (MAP) in a large series of patients, for both EO-PE and late onset PE (LO-PE; delivery ≥ 34 weeks).
This was a nested case-control study, using stored first-trimester maternal serum from women who developed EO-PE (n = 68) or LO-PE (n = 99), and 500 uncomplicated singleton pregnancies. Maternal characteristics, MAP, and pregnancy outcome were collected for each individual woman and used to calculate prior risks for PE in a multiple logistic regression model. Models containing prior PE risks, serum markers, and MAP were developed for the prediction of EO-PE and LO-PE. The model-predicted detection rates (DR) for fixed 10% false-positive rates were calculated for EO-PE and LO-PE with or without the presence of a small-for-gestational age infant (SGA, birth weight <10(th) centile).
The best prediction model included maternal characteristics, MAP, PAPP-A, ADAM12, and PlGF, with DR of 72% for EO-PE and 49% for LO-PE. Prediction for PE with concomitant SGA was better than for PE alone (92% for EO-PE and 57% for LO-PE).
First-trimester MAP, PAPP-A, ADAM12, and PlGF combined with maternal characteristics and MAP are promising markers in the risk assessment of PE, especially for EO-PE complicated by SGA.
在之前的一项研究中，我们描述了妊娠相关血浆蛋白 A（PAPP-A）、人绒毛膜促性腺激素游离β亚基（fβ-hCG）、胎盘生长因子（PlGF）和 A 型解整合素金属蛋白酶 12（ADAM12）在预测早期子痫前期（EO-PE；<34 周分娩）中的价值。本研究的目的是在大量患者中获得这些血清标志物与母亲特征和早期妊娠平均动脉压（MAP）相结合的预测价值，用于预测 EO-PE 和晚期子痫前期（LO-PE；≥34 周分娩）。
这是一项嵌套病例对照研究，使用来自发生 EO-PE（n=68）或 LO-PE（n=99）的孕妇的存储的早期妊娠母亲血清，以及 500 例正常的单胎妊娠。收集每位女性的母亲特征、MAP 和妊娠结局，并用于多因素逻辑回归模型计算 PE 的先验风险。为预测 EO-PE 和 LO-PE，建立了包含先验 PE 风险、血清标志物和 MAP 的模型。对于有或没有胎儿生长受限（SGA，出生体重<第 10 百分位数）的 EO-PE 和 LO-PE，计算了固定假阳性率为 10%的模型预测检出率（DR）。
最佳预测模型包括母亲特征、MAP、PAPP-A、ADAM12 和 PlGF，EO-PE 的 DR 为 72%，LO-PE 的 DR 为 49%。PE 合并 SGA 的预测效果优于单独的 PE（EO-PE 的 92%和 LO-PE 的 57%）。
早期妊娠 MAP、PAPP-A、ADAM12 和 PlGF 与母亲特征和 MAP 相结合是评估 PE 风险的有前途的标志物，尤其是对合并 SGA 的 EO-PE。
