Zhao Mutong, Zhu Zhiqing, Liu Chongdong, Zhang Zhenyu
Department of Obstetrics and Gynecology, Beijng Chao-yang Hospital, Capital Medical University, Beijing, 100020, People's Republic of China.
Arch Gynecol Obstet. 2017 May;295(5):1079-1087. doi: 10.1007/s00404-017-4302-3. Epub 2017 Mar 17.
To systematically review the approach of using two independent sFlt-1/PlGF cutoffs that has better sensitivity (cutoff-sen) and specificity (cutoff-spe) separately for risk stratification in the detection of preeclampsia.
PubMed and Embase databases and reference lists were searched up to June 2016. Inclusion criteria were blood samples for sFlt-1/PlGF with separate cutoffs (cutoff-sen and cutoff-spe) provided. Six relevant studies were identified. Pooling of results was done based on three studies and a systematic review was performed based on all six.
The strategy of using a cutoff of ≤33 and ≥85 for early onset preeclampsia, and ≤33 and ≥110 for the late onset preeclampsia was proposed and examined. The pooled sensitivity for cutoff-sen was: 95.3% (90.6-98.1%) and 88.6% (82.9-92.9%) for early and late onset preeclampsia, respectively. The pooled specificity for cutoff-spe was: 97.6% (95.2-98.9%) and 94.2% (91.4-96.3%) for early and late onset preeclampsia respectively. The pooled estimation of the early onset pre-eclamptic pregnancies and control normal pregnancies classified in the equivocal zone was 4.9% (2.0-8.8%) and 32.4% (25.7-39.5%), respectively, and 26.8% (10.3-47.6%) and 8.7% (3.0-17.6%) for late onset patients.
The new dual-cutoff diagnostic system optimizes the predictive performance of the single cutoff system. Further studies are required to assess the performance of this system and to define the approach and frequency at which subjects in the equivocal zone should be screened.
系统评价分别使用两个具有更好敏感性（临界值敏感性）和特异性（临界值特异性）的独立可溶性fms样酪氨酸激酶-1（sFlt-1）/胎盘生长因子（PlGF）临界值进行子痫前期检测风险分层的方法。
检索截至2016年6月的PubMed和Embase数据库及参考文献列表。纳入标准为提供了具有单独临界值（临界值敏感性和临界值特异性）的sFlt-1/PlGF血样。确定了6项相关研究。基于3项研究进行结果合并，并基于所有6项研究进行系统评价。
提出并检验了早发型子痫前期临界值≤33和≥85，晚发型子痫前期临界值≤33和≥110的策略。临界值敏感性的合并敏感性分别为：早发型子痫前期95.3%（90.6-98.1%），晚发型子痫前期88.6%（82.9-92.9%）。临界值特异性的合并特异性分别为：早发型子痫前期97.6%（95.2-98.9%），晚发型子痫前期94.2%（91.4-96.3%）。早发型子痫前期妊娠和对照正常妊娠分类在可疑区间的合并估计分别为4.9%（2.0-8.8%）和32.4%（25.7-39.5%），晚发型患者分别为26.8%（10.3-47.6%）和8.7%（3.0-17.6%）。
新的双临界值诊断系统优化了单临界值系统的预测性能。需要进一步研究来评估该系统的性能，并确定对可疑区间受试者进行筛查的方法和频率。
