Saleh Langeza, Verdonk Koen, Jan Danser A H, Steegers Eric A P, Russcher Henk, van den Meiracker Anton H, Visser Willy
Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, The Netherlands; Department of Obstetrics and Gynecology, The Netherlands.
Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2016 Apr;199:121-6. doi: 10.1016/j.ejogrb.2016.02.013. Epub 2016 Feb 18.
To evaluate the additive value of the sFlt-1/PlGF ratio for diagnosing preeclampsia (PE) and predicting prolongation of pregnancy and adverse outcome in a cohort of women with PE or at high risk of PE.
Patients with suspected or confirmed clinical PE were recruited. At time of inclusion blood for measurement of sFlt-1and PlGF was taken. Values were determined after delivery. A cut-off ratio of ≥85 was defined as a positive test.
A total of 107 patients were included. Of the patients, 62 (58%) met the clinical criteria of PE at time of blood sampling. In 10% of these patients (n=6) the ratio was <85 (false negative), whereas in 7% (n=3) of patients without clinical PE the ratio was ≥85 (false positive), resulting in positive and negative predictive values of 95% and 88% respectively. One patient with false positive ratio developed superimposed PE and 2 developed gestational hypertension, and adverse outcome occurred in all three. An adverse pregnancy outcome was only encountered in 1 of the 6 patients with a false negative ratio. Using a binary regression model with adjustment for gestational age <34 weeks, the adverse outcome risk was 11 times increased on the basis of clinical PE, and 30 times on the basis of an elevated ratio (P=0.036).
The additive value of an increased ratio for diagnosing PE is limited since most patients with clinical PE also have a positive ratio. However, an elevated ratio is superior to the clinical diagnosis of PE for predicting an adverse pregnancy outcome. Furthermore, irrespective of clinical PE, a low ratio is inversely correlated with prolongation of pregnancy.
评估可溶性血管内皮生长因子受体-1（sFlt-1）与胎盘生长因子（PlGF）比值在诊断子痫前期（PE）以及预测PE患者或PE高危女性妊娠延长和不良结局方面的附加价值。
招募疑似或确诊临床PE的患者。纳入研究时采集血液用于检测sFlt-1和PlGF。分娩后确定检测值。将比值≥85定义为阳性检测结果。
共纳入107例患者。其中，62例（58%）患者在采血时符合PE临床标准。这些患者中10%（n = 6）的比值<85（假阴性），而无临床PE的患者中有7%（n = 3）的比值≥85（假阳性），阳性预测值和阴性预测值分别为95%和88%。1例假阳性比值的患者发生了叠加性PE，2例发生了妊娠期高血压，这3例均出现了不良结局。6例假阴性比值的患者中仅1例出现不良妊娠结局。使用校正孕周<34周的二元回归模型，基于临床PE，不良结局风险增加11倍，基于比值升高则增加30倍（P = 0.036）。
由于大多数临床PE患者的比值也为阳性，因此比值升高在诊断PE方面的附加价值有限。然而，比值升高在预测不良妊娠结局方面优于PE的临床诊断。此外，无论临床PE情况如何，低比值与妊娠延长呈负相关。
