Kuessel Lorenz, Zeisler Harald, Ristl Robin, Binder Julia, Pateisky Petra, Schmid Maximilian, Marschalek Julian, Perkmann Thomas, Haslacher Helmuth, Husslein Heinrich
Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringerguertel 18-20, A-1090, Vienna, Austria.
Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
BMC Pregnancy Childbirth. 2016 Nov 3;16(1):339. doi: 10.1186/s12884-016-1132-4.
The ability to identify patients at risk for developing preeclampsia is important for preventing morbidity and mortality in both the mother and child. Although CYFRA 21-1 (a fragment of Cytokeratin 19) is considered a promising biomarker for diagnosing preeclampsia, little is known regarding the levels of CYFRA 21-1 during pregnancy. Here, we measured serum CYFRA 21-1 levels in women with an uneventful pregnancy and in women whose pregnancy was complicated by preeclampsia. Furthermore we evaluated whether maternal CYFRA 21-1 levels can be used to predict and/or diagnose preeclampsia.
Longitudinal, sequential blood samples were collected prospectively at seven predetermined visits during pregnancy. Maternal CYFRA 21-1 levels were measured in 50 women with an uneventful pregnancy (control group) and in 10 asymptomatic women whose pregnancy was later complicated by preeclampsia (PE_long group). In addition, CYFRA 21-1 levels were measured from a single sample collected from a separate group of 50 pregnant women with symptomatic preeclampsia (PE_state group).
The CYFRA 21-1 levels were significantly higher in the PE_state group compared to the control group (p < 0.001). In the PE_long group, CYFRA 21-1 levels were lower from gestational week 11 through 17, but were higher than the control group from gestational weeks 18 through 36. Out of the ROC curves that were calculated to investigate the predictive and diagnostic properties of CYFRA 21-1 levels for preeclampsia, the ROC curve for diagnosing preeclampsia in gestational week 28-32 showed the largest AUC of 0.92, at a cut-off point of 3.1 ng/ml, leading to sensitivity of 92 % and specificity of 80 %.
The elevated serum levels of CYFRA 21-1 observed in both groups of women with preeclampsia may reflect endothelial damage and/or dysfunction. Our results suggest that maternal serum CYFRA 21-1 is a promising biomarker for diagnosing preeclampsia. Although its value for predicting the long-term occurrence of subsequent preeclampsia may be limited, our findings indicate a trend towards elevated maternal CYFRA 21-1 levels preceding the short-term occurrence of preeclampsia in asymptomatic women. Additional prospective longitudinal studies are needed in order to determine the value of measuring maternal serum CYFRA 21-1 in predicting preeclampsia.
识别有发生先兆子痫风险的患者对于预防母婴发病和死亡至关重要。尽管细胞角蛋白19片段CYFRA 21 - 1被认为是诊断先兆子痫的一种有前景的生物标志物，但关于孕期CYFRA 21 - 1水平的了解却很少。在此，我们测量了妊娠过程顺利的女性以及妊娠合并先兆子痫女性的血清CYFRA 21 - 1水平。此外，我们评估了母体CYFRA 21 - 1水平是否可用于预测和/或诊断先兆子痫。
在孕期七个预定的访视时间前瞻性地收集纵向、连续的血样。测量了50例妊娠过程顺利的女性（对照组）以及10例妊娠后期并发先兆子痫的无症状女性（PE_long组）的母体CYFRA 21 - 1水平。此外，从另一组50例有症状先兆子痫的孕妇（PE_state组）采集的单个样本中测量了CYFRA 21 - 1水平。
PE_state组的CYFRA 21 - 1水平显著高于对照组（p < 0.001）。在PE_long组中，CYFRA 21 - 1水平在妊娠第11周至17周较低，但在妊娠第18周至36周高于对照组。在为研究CYFRA 21 - 1水平对先兆子痫的预测和诊断特性而计算的ROC曲线中，妊娠第28 - 32周诊断先兆子痫的ROC曲线显示最大AUC为0.92，截断点为3.1 ng/ml，灵敏度为92%，特异性为80%。
在两组先兆子痫女性中观察到的血清CYFRA 21 - 1水平升高可能反映了内皮损伤和/或功能障碍。我们的结果表明母体血清CYFRA 21 - 1是诊断先兆子痫的一种有前景的生物标志物。尽管其预测后续先兆子痫长期发生的价值可能有限，但我们的研究结果表明在无症状女性中，先兆子痫短期发生之前母体CYFRA 21 - 1水平有升高的趋势。需要进行更多的前瞻性纵向研究以确定测量母体血清CYFRA 21 - 1在预测先兆子痫方面的价值。
