循环血管生成因子与海地先兆子痫妇女不良结局风险
Circulating Angiogenic Factors and the Risk of Adverse Outcomes among Haitian Women with Preeclampsia.
作者信息
March Melissa I, Geahchan Carl, Wenger Julia, Raghuraman Nandini, Berg Anders, Haddow Hamish, Mckeon Bri Ann, Narcisse Rulx, David Jean Louis, Scott Jennifer, Thadhani Ravi, Karumanchi S Ananth, Rana Sarosh
机构信息
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Division of Maternal Fetal Medicine/Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America.
Center for Vascular Biology and Research, Beth Israel Deaconess Medical Center Boston, MA, United States of America.
出版信息
PLoS One. 2015 May 12;10(5):e0126815. doi: 10.1371/journal.pone.0126815. eCollection 2015.
OBJECTIVE
Angiogenic factors are strongly associated with adverse maternal and fetal outcomes among women with preterm preeclampsia (PE) in developed countries. We evaluated the role of angiogenic factors and their relationship to adverse outcomes among Haitian women with PE.
MATERIAL AND METHODS
We measured plasma antiangiogenic soluble fms-like tyrosine kinase 1 (sFlt1) and proangiogenic placental growth factor (PlGF) levels in women with PE (n=35) compared to controls with no hypertensive disorders (NHD) (n=43) among subjects with singleton pregnancies that delivered at Hospital Albert Schweitzer (HAS) in Haiti. We divided the preeclamptic women into two groups, early onset (≤ 34 weeks) and late onset (>34 weeks) and examined relationships between sFlt1/PlGF ratios on admission and adverse outcomes (abruption, respiratory complications, stroke, renal insufficiency, eclampsia, maternal death, birth weight <2500 grams, or fetal/neonatal death) in women with PE subgroups as compared to NHD groups separated by week of admission. Data are presented as median (25th-75th centile), n (%), and proportions.
RESULTS
Among patients with PE, most (24/35) were admitted at term. Adverse outcome rates in PE were much higher among the early onset group compared to the late onset group (100.0% vs. 54.2%, P=0.007). Plasma angiogenic factors were dramatically altered in both subtypes of PE. Angiogenic factors also correlated with adverse outcomes in both subtypes of PE. The median sFlt1/PlGF ratios for subjects with early onset PE with any adverse outcome vs. NHD <=34 weeks with no adverse outcome were 703.1 (146.6, 1614.9) and 9.6 (3.5, 58.6); P<0.001). Among late onset group the median sFlt1/PlGF ratio for women with any adverse outcome was 130.7 (56.1, 242.6) versus 22.4 (10.2, 58.7; P=0.005) in NHD >34 weeks with no adverse outcome.
CONCLUSION
PE-related adverse outcomes are common in women in Haiti and are associated with profound angiogenic imbalance regardless of gestational age at presentation.
目的
在发达国家，血管生成因子与早发型子痫前期（PE）女性的不良母婴结局密切相关。我们评估了血管生成因子在海地PE女性中的作用及其与不良结局的关系。
材料与方法
在海地阿尔贝·施韦泽医院（HAS）分娩的单胎妊娠受试者中，我们测量了35例PE女性与43例无高血压疾病（NHD）对照女性的血浆抗血管生成可溶性fms样酪氨酸激酶1（sFlt1）和促血管生成胎盘生长因子（PlGF）水平。我们将子痫前期女性分为两组，早发型（≤34周）和晚发型（>34周），并比较了入院时sFlt1/PlGF比值与PE亚组女性不良结局（胎盘早剥、呼吸并发症、中风、肾功能不全、子痫、孕产妇死亡、出生体重<2500克或胎儿/新生儿死亡）之间的关系，与按入院周数分开的NHD组进行比较。数据以中位数（第25-75百分位数）、n（%）和比例表示。
结果
在PE患者中，大多数（24/35）在足月时入院。早发型组PE的不良结局发生率远高于晚发型组（100.0%对54.2%，P=0.007）。两种PE亚型的血浆血管生成因子均发生了显著变化。血管生成因子也与两种PE亚型的不良结局相关。早发型PE伴任何不良结局的受试者与≤34周无不良结局的NHD受试者的sFlt1/PlGF比值中位数分别为703.1（146.6，1614.9）和9.6（3.5，58.6）；P<0.001）。在晚发型组中，有任何不良结局的女性的sFlt1/PlGF比值中位数为130.7（56.1，242.6），而>34周无不良结局的NHD女性为22.4（10.2，58.7；P=0.005）。
结论
PE相关的不良结局在海地女性中很常见，并且与血管生成的严重失衡有关，无论发病时的孕周如何。
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