Engels Theresa, Pape Juliane, Schoofs Katharina, Henrich Wolfgang, Verlohren Stefan
Department of Obstetrics, Charité University Medicine , Berlin , Germany .
Hypertens Pregnancy. 2013 Nov;32(4):459-73. doi: 10.3109/10641955.2013.827205. Epub 2013 Aug 19.
The utility of angiogenic and antiangiogenic biomarkers as diagnostic tools in preeclampsia (PE) has been shown in previous studies. Our study's aim was to evaluate the use of automated measurement of sFlt1, PlGF and their ratio (sFlt1/PlGF) in differential diagnosis of hypertensive pregnancy disorders.
PATIENTS/METHODS: Sixty-four patients with PE/HELLP, 18 with pregnancy-induced hypertension (PIH), 22 with gestational proteinuria (GP) and 232 controls were investigated. The PE/HELLP group was divided into mild PE (mPE, n=31), severe PE (sevPE, n=20), superimposed PE (supPE, n=7) and HELLP syndrome (n=6). sFlt1 and PlGF were measured in serum samples on an automated platform. Statistical analysis was performed using parametric and non-parametric methods, ROC analysis and logistic regression method.
PE patients showed higher sFlt1 and ratio and lower PlGF than controls (median ± SEM in pg/mL; 10888 ± 878 versus 2456 ± 116; 268 ± 39 versus 16 ± 2 and 68 ± 6 versus 439 ± 37, each p<0.001), subgroups showed similar differences in ratios (median ± SEM; supPE: 202 ± 110; mPE: 137 ± 27; sevPE: 497 ± 91; HELLP syndrome: 254 ± 72 versus controls 16 ± 2, each p<0.001). ROC analysis showed best performance for sFlt1/PlGF (AUC all PE: ratio 96.4%, sFlt1 92.8%, PlGF 92.4%, supPE: ratio 93.6%, mPE: ratio 94.8%, sevPE: ratio 99.4%, HELLP: ratio 98.6%, each versus controls). Patients with PIH and GP showed significant differences compared to controls (p ≤ 0.01, respectively), mPE (p ≤ 0.007), sevPE (p<0.001) and HELLP syndrome (p ≤ 0.003).
The automated measurement of sFlt1/PlGF is a reliable diagnostic tool in differential diagnosis of hypertensive pregnancy disorders and gives additional valuable information for clinical management.
既往研究已显示血管生成和抗血管生成生物标志物作为子痫前期（PE）诊断工具的效用。本研究的目的是评估自动检测可溶性血管内皮生长因子受体1（sFlt1）、胎盘生长因子（PlGF）及其比值（sFlt1/PlGF）在高血压妊娠疾病鉴别诊断中的应用。
患者/方法：对64例PE/HELLP综合征患者、18例妊娠高血压（PIH）患者、22例妊娠蛋白尿（GP）患者和232例对照进行了研究。PE/HELLP组分为轻度PE（mPE，n = 31）、重度PE（sevPE，n = 20）、叠加性PE（supPE，n = 7）和HELLP综合征（n = 6）。在自动检测平台上检测血清样本中的sFlt1和PlGF。采用参数和非参数方法、ROC分析和逻辑回归方法进行统计分析。
PE患者的sFlt1及其比值高于对照组，而PlGF低于对照组（pg/mL为中位数±标准误；10888±878对2456±116；268±39对16±2；68±6对439±37，各p<0.001），各亚组在比值上显示出相似差异（中位数±标准误；supPE组：202±110；mPE组：137±27；sevPE组：497±91；HELLP综合征组：254±72对对照组16±2，各p<0.001）。ROC分析显示sFlt1/PlGF表现最佳（所有PE组：比值AUC为96.4%，sFlt1为92.8%，PlGF为92.4%；supPE组：比值AUC为93.6%；mPE组：比值AUC为94.8%；sevPE组：比值AUC为99.4%；HELLP组：比值AUC为98.6%，各与对照组比较）。PIH和GP患者与对照组相比有显著差异（分别为p≤0.01），与mPE组相比（p≤0.007），与sevPE组相比（p<0.001）以及与HELLP综合征组相比（p≤0.003）。
自动检测sFlt1/PlGF是高血压妊娠疾病鉴别诊断中的可靠诊断工具，可为临床管理提供额外有价值的信息。
