Lobmaier S M, Figueras F, Mercade I, Perello M, Peguero A, Crovetto F, Ortiz J U, Crispi F, Gratacós E
Maternal-Fetal Medicine Department, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Fetal and Perinatal Medicine Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain; Frauenklinik und Poliklinik, Technische Universität München, Munich, Germany.
Ultrasound Obstet Gynecol. 2014 May;43(5):533-40. doi: 10.1002/uog.13246. Epub 2014 Mar 27.
To compare the value of Doppler surveillance with maternal blood angiogenic factors at diagnosis for the prediction of adverse outcome in late-pregnancy small-for-gestational-age (SGA) fetuses.
In a cohort of 198 SGA fetuses we evaluated the association of Doppler indices (mean uterine artery pulsatility index (UtA-PI) and cerebroplacental ratio (CPR)) and angiogenic factors (maternal serum levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF)) with the development of pre-eclampsia and adverse perinatal outcome (operative delivery for non-reassuring fetal status or neonatal metabolic acidosis).
In SGA fetuses subsequently developing pre-eclampsia, mean UtA-PI (P < 0.001), sFlt-1 MoM (P < 0.001) and sFlt-1/PlGF MoM ratio (P < 0.001) were higher, while PlGF MoM was lower (P = 0.004). In SGA fetuses with adverse perinatal outcome, CPR (P < 0.002) and PlGF MoM (P < 0.001) were lower, and sFlt-1/PlGF MoM ratio was higher (P = 0.001). For predicting pre-eclampsia, the areas under the receiver-operating characteristics (ROC) curves for mean UtA-PI, sFlt-1 MoM and the combination of both were 0.852, 0.839 and 0.860, respectively. For adverse perinatal outcome, the areas under the ROC curves for CPR, PlGF MoM and the combination of both were 0.652, 0.656 and 0.684, respectively. The combination of Doppler indices and angiogenic factors did not significantly improve prediction of either pre-eclampsia (P = 0.851) or adverse outcome (P = 0.579).
In SGA fetuses, angiogenic factors at diagnosis and follow-up with Doppler ultrasound both predict adverse outcome with a similar performance.
比较多普勒监测与母体血液血管生成因子在诊断时预测晚期妊娠小于胎龄（SGA）胎儿不良结局的价值。
在198例SGA胎儿队列中，我们评估了多普勒指标（平均子宫动脉搏动指数（UtA-PI）和脑胎盘比值（CPR））以及血管生成因子（母体血清可溶性fms样酪氨酸激酶-1（sFlt-1）和胎盘生长因子（PlGF）水平）与子痫前期发生及围产期不良结局（因胎儿状况不佳行手术分娩或新生儿代谢性酸中毒）之间的关联。
在随后发生子痫前期的SGA胎儿中，平均UtA-PI（P<0.001）、sFlt-1倍数中位数（MoM）（P<0.001）和sFlt-1/PlGF MoM比值（P<0.001）较高，而PlGF MoM较低（P = 0.004）。在有围产期不良结局的SGA胎儿中，CPR（P<0.002）和PlGF MoM（P<0.001）较低，sFlt-1/PlGF MoM比值较高（P = 0.001）。对于预测子痫前期，平均UtA-PI、sFlt-1 MoM及两者联合的受试者工作特征（ROC）曲线下面积分别为0.852、0.839和0.860。对于围产期不良结局，CPR、PlGF MoM及两者联合的ROC曲线下面积分别为0.652、0.656和0.684。多普勒指标与血管生成因子联合并未显著改善子痫前期（P = 0.851）或不良结局（P = 0.579）的预测。
在SGA胎儿中，诊断时的血管生成因子及多普勒超声随访均能以相似的效能预测不良结局。
