Straughen Jennifer K, Misra Dawn P, Helmkamp Laura, Misra Vinod K
1 Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.
2 Department of Family Medicine and Public Health Sciences, The Wayne State University School of Medicine, Detroit, MI, USA.
Reprod Sci. 2017 Dec;24(12):1583-1589. doi: 10.1177/1933719117698574. Epub 2017 Mar 24.
Preterm delivery (PTD) may be characterized by altered interrelationships among angiogenic factors and measures of placental function. We analyzed the longitudinal relationship between maternal serum concentrations of soluble fms-like tyrosine kinase 1 (sFlt1), an important antiangiogenic factor, and uterine artery resistance in pregnancies resulting in preterm and term deliveries.
Data were collected in a longitudinal cohort study involving 278 women monitored at 6 to 10, 10 to 14, 16 to 20, 22 to 26, and 32 to 36 weeks of gestation. Concentrations of maternal serum sFlt1 were determined using solid-phase enzyme-linked immunosorbent assay, and uterine artery resistance indices (RI) were measured by Doppler velocimetry at each interval. Preterm delivery was defined as birth before 37-weeks completed gestation. Data analyses used multivariable repeated measures regression models.
Uterine artery RI decreased across gestation. As pregnancy progressed, RI trajectories diverged for term and preterm deliveries; the mean RI was significantly higher in third trimester for pregnancies resulting in PTD ( P = .08). sFlt1 was stable through 21 3/7 weeks of gestation and then increased rapidly; women who delivered preterm had significantly higher sFlt1 levels in the third trimester ( P = .04). The relationship between uterine artery RI and sFlt1 from the prior visit was significantly different between the groups ( P < .0001). For term deliveries, higher sFlt1 concentrations were associated with a smaller RI at the subsequent visit (β = -.08, 95% confidence interval [CI]: -0.14 to -0.02). For PTD, higher sFlt1 concentrations were associated with a larger uterine artery RI (β = .14, 95% CI: 0.06 to 0.22).
PTD is characterized by altered relationships between angiogenic factors and placental vascular blood flow starting in early pregnancy.
早产（PTD）的特征可能是血管生成因子与胎盘功能指标之间的相互关系发生改变。我们分析了可溶性fms样酪氨酸激酶1（sFlt1，一种重要的抗血管生成因子）的母体血清浓度与导致早产和足月分娩的妊娠中子宫动脉阻力之间的纵向关系。
在一项纵向队列研究中收集数据，该研究涉及278名妇女，在妊娠6至10周、10至14周、16至20周、22至26周以及32至36周进行监测。使用固相酶联免疫吸附测定法测定母体血清sFlt1的浓度，并在每个时间段通过多普勒测速法测量子宫动脉阻力指数（RI）。早产定义为妊娠37周前分娩。数据分析使用多变量重复测量回归模型。
子宫动脉RI在整个妊娠期降低。随着妊娠进展，足月和早产的RI轨迹出现分歧；导致早产的妊娠在孕晚期的平均RI显著更高（P = 0.08）。sFlt1在妊娠21 3/7周之前保持稳定，然后迅速升高；早产妇女在孕晚期的sFlt1水平显著更高（P = 0.04）。两组之间子宫动脉RI与前次就诊时sFlt1的关系显著不同（P < 0.0001）。对于足月分娩，较高的sFlt1浓度与随后就诊时较小的RI相关（β = -0.08，95%置信区间[CI]：-0.14至-0.02）。对于早产，较高的sFlt1浓度与较大的子宫动脉RI相关（β = 0.14，95%CI：0.06至0.22）。
早产的特征是从妊娠早期开始血管生成因子与胎盘血管血流之间的关系发生改变。
