Kane Stefan C
Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Pregnancy Research Centre, Department of Maternal-Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia.
Obstet Med. 2016 Sep;9(3):106-12. doi: 10.1177/1753495X16649074. Epub 2016 May 14.
The commercial availability of tests in the first trimester of pregnancy that predict the later development of pre-eclampsia has prompted considerable debate regarding their clinical utility and the degree to which they fulfil the longstanding principles of screening. Such tests have been shown to achieve detection rates for early pre-eclampsia (requiring delivery prior to 34 weeks) of over 90%, for a false positive rate of 10%. However, their capacity to predict later onset pre-eclampsia, which accounts for the bulk of the disease burden, is much more limited. The relatively few studies validating the performance of these tests in different populations have demonstrated significant variations in performance. Moreover, prospective research confirming that the administration of aspirin to those screened to be high risk reduces the incidence of pre-eclampsia is yet to be completed, and there may be harms in restricting aspirin therapy to this group, given its broader beneficial effect. In light of these limitations, further development of these tests is recommended prior to their introduction to clinical practice.
在妊娠早期可进行预测子痫前期后期发展的检测，这引发了关于其临床实用性以及它们在多大程度上符合长期筛查原则的大量争论。此类检测已显示，对于早期子痫前期（需在34周前分娩）的检出率超过90%，假阳性率为10%。然而，它们预测后期发病的子痫前期的能力要有限得多，而后期发病的子痫前期占疾病负担的大部分。相对较少的验证这些检测在不同人群中性能的研究表明，性能存在显著差异。此外，证实对筛查为高危人群服用阿司匹林可降低子痫前期发病率的前瞻性研究尚未完成，鉴于阿司匹林具有更广泛的有益作用，将其治疗仅限于该组人群可能存在危害。鉴于这些局限性，建议在将这些检测引入临床实践之前进一步研发。
