sFlt-1/PlGF 用于预测早发型子痫前期：STEPs（西班牙子痫前期研究）。
sFlt-1/PlGF for prediction of early-onset pre-eclampsia: STEPS (Study of Early Pre-eclampsia in Spain).
机构信息
Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Universidad de Murcia and IMIB-Arrixaca, Murcia, Spain.
出版信息
Ultrasound Obstet Gynecol. 2017 Sep;50(3):373-382. doi: 10.1002/uog.17373.
OBJECTIVE
A high ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) has been linked to pre-eclampsia (PE). We evaluated the sFlt-1/PlGF ratio as a predictive marker for early-onset PE in women at risk of PE.
METHODS
This prospective, Spanish, multicenter study included pregnant women with a risk factor for PE, including intrauterine growth restriction, PE, eclampsia or hemolysis, elevated liver enzymes and low platelet count syndrome in previous pregnancy, pregestational diabetes or abnormal uterine artery Doppler. The primary objective was to show that the sFlt-1/PlGF ratio at 20, 24 and 28 weeks' gestation was predictive of early-onset PE (< 34 + 0 weeks). Serum sFlt-1 and PlGF were measured at 20, 24 and 28 weeks. Multivariate logistic regression was used to develop a predictive model.
RESULTS
A total of 819 women were enrolled, of which 729 were suitable for analysis. Of these, 78 (10.7%) women developed PE (24 early onset and 54 late onset). Median sFlt-1/PlGF ratio at 20, 24 and 28 weeks was 6.3 (interquartile range (IQR), 4.1-9.3), 4.0 (IQR, 2.6-6.3) and 3.3 (IQR, 2.0-5.9), respectively, for women who did not develop PE (controls); 14.5 (IQR, 5.5-43.7), 18.4 (IQR, 8.2-57.9) and 51.9 (IQR, 11.5-145.6) for women with early-onset PE; and 6.7 (IQR, 4.6-9.9), 4.7 (IQR, 2.8-7.2) and 6.0 (IQR, 3.8-10.5) for women with late-onset PE. Compared with early-onset PE, the sFlt-1/PlGF ratio was significantly lower in controls (P < 0.001 at each timepoint) and in women with chronic hypertension (P < 0.001 at each timepoint), gestational hypertension (P < 0.001 at each timepoint) and late-onset PE (P < 0.001 at each timepoint). A prediction model for early-onset PE was developed, which included the sFlt-1/PlGF ratio plus mean arterial pressure, being parous and previous PE, with areas under the receiver-operating characteristics curves of 0.86 (95% CI, 0.77-0.95), 0.91 (95% CI, 0.85-0.97) and 0.93 (95% CI, 0.86-0.99) at 20, 24 and 28 weeks, respectively, and was superior to models using the sFlt-1/PlGF ratio alone or uterine artery mean pulsatility index.
CONCLUSIONS
The sFlt-1/PlGF ratio can improve prediction of early-onset PE for women at risk of this condition. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
目的
可溶性 fms 样酪氨酸激酶-1（sFlt-1）与胎盘生长因子（PlGF）的比值升高与先兆子痫（PE）有关。我们评估了 sFlt-1/PlGF 比值作为预测高危孕妇发生早发型 PE 的指标。
方法
本前瞻性、多中心、西班牙研究纳入了具有 PE 风险的孕妇，包括胎儿生长受限、PE、子痫前期、HELLP 综合征、前次妊娠子痫前期、糖尿病或子宫动脉多普勒异常。主要目的是显示 20、24 和 28 孕周时 sFlt-1/PlGF 比值可预测早发型 PE（<34+0 周）。在 20、24 和 28 孕周时测量血清 sFlt-1 和 PlGF。采用多变量逻辑回归建立预测模型。
结果
共纳入 819 名孕妇，其中 729 名适合分析。其中，78 名（10.7%）孕妇发生了 PE（24 例早发型，54 例晚发型）。未发生 PE 的孕妇（对照组）20、24 和 28 孕周时 sFlt-1/PlGF 比值中位数分别为 6.3（四分位距（IQR），4.1-9.3）、4.0（IQR，2.6-6.3）和 3.3（IQR，2.0-5.9）；早发型 PE 组分别为 14.5（IQR，5.5-43.7）、18.4（IQR，8.2-57.9）和 51.9（IQR，11.5-145.6）；晚发型 PE 组分别为 6.7（IQR，4.6-9.9）、4.7（IQR，2.8-7.2）和 6.0（IQR，3.8-10.5）。与早发型 PE 相比，对照组（各时间点 P<0.001）和慢性高血压（各时间点 P<0.001）、妊娠期高血压（各时间点 P<0.001）和晚发型 PE （各时间点 P<0.001）孕妇的 sFlt-1/PlGF 比值显著降低。建立了早发型 PE 的预测模型，该模型包括 sFlt-1/PlGF 比值加平均动脉压、产次和前次 PE，20、24 和 28 孕周时受试者工作特征曲线下面积分别为 0.86（95%CI，0.77-0.95）、0.91（95%CI，0.85-0.97）和 0.93（95%CI，0.86-0.99），优于单独使用 sFlt-1/PlGF 比值或子宫动脉平均搏动指数的模型。
结论
sFlt-1/PlGF 比值可提高高危孕妇发生早发型 PE 的预测能力。版权所有©2017 ISUOG。由 John Wiley & Sons Ltd 出版。
Zotero 插件