评估胎盘生长因子（PlGF）检测与可溶性FMS样酪氨酸激酶1（sFlt-1）/PlGF比值的一致性，比较子痫前期预测准确性，并探讨其与子宫动脉多普勒及阿司匹林反应的关系。
Evaluation of agreement of placental growth factor (PlGF) tests and the soluble FMS-like tyrosine kinase 1 (sFlt-1)/PlGF ratio, comparison of predictive accuracy for pre-eclampsia, and relation to uterine artery Doppler and response to aspirin.
作者信息
Navaratnam Kate, Abreu Patricia, Clarke Helen, Jorgensen Andrea, Alfirevic Ana, Alfirevic Zarko
机构信息
a Centre for Women's Health Research, Institute of Translational Medicine , University of Liverpool , Liverpool , UK.
b Liverpool Women's Hospital , Liverpool , UK.
出版信息
J Matern Fetal Neonatal Med. 2019 Jan;32(2):179-187. doi: 10.1080/14767058.2017.1373760. Epub 2017 Sep 11.
OBJECTIVES
The objective of this study is to evaluate agreement between PlGF and sFlt-1/PlGF ratio tests and compare their predictive accuracy for pre-eclampsia in high-risk women. Also, to examine for associations of abnormal PlGF or sFlt-1/PlGF ratio with abnormal uterine artery Doppler and platelet response to aspirin.
METHODS
Prospective cohort study, 150 pregnant women at high risk of pre-eclampsia prescribed 75 mg aspirin daily. Uterine artery Dopplers were assessed at 20-23 weeks. At 33-35 weeks platelet function aspirin metabolites, PlGF and the sFlt-1/PlGF ratio were measured.
OUTCOME
Measures were all pre-eclampsia and pre-eclampsia requiring delivery prior to 37 weeks.
RESULTS
Overall percent agreement was 89.3% for PlGF tests but 74.7-78% for PlGF tests and the sFlt-1/PlGF ratio. AUCs were 0.70-0.75 for prediction of any pre-eclampsia and 0.92-0.99 for preterm pre-eclampsia. We found a significant association between abnormal PlGF or sFlt-1/PlGF ratio and abnormal uterine artery Doppler (χ 5.47, p = .019), but no association with platelet response to aspirin (χ 0.12, p = .913). There were no associations between suboptimal aspirin adherence and either abnormal angiogenic markers or uterine artery Dopplers (χ 0.144, 0.038, p = .704, .846, respectively).
CONCLUSIONS
There was good agreement between PlGF tests and limited agreement between PlGF tests and the sFlt-1/PlGF ratio. All tests have heightened predictive accuracy for preterm pre-eclampsia. Abnormal PlGF or sFlt-1/PlGF ratio relates to abnormal uterine artery Doppler but not platelet response to aspirin.
目的
本研究的目的是评估胎盘生长因子（PlGF）和可溶性血管内皮生长因子受体-1/胎盘生长因子（sFlt-1/PlGF）比值检测之间的一致性，并比较它们对高危女性先兆子痫的预测准确性。此外，研究异常的PlGF或sFlt-1/PlGF比值与子宫动脉多普勒异常以及血小板对阿司匹林反应之间的关联。
方法
前瞻性队列研究，150名先兆子痫高危孕妇，每天服用75毫克阿司匹林。在孕20 - 23周时评估子宫动脉多普勒。在孕33 - 35周时测量血小板功能、阿司匹林代谢产物、PlGF和sFlt-1/PlGF比值。
结果
PlGF检测的总体一致性百分比为89.3%，但PlGF检测与sFlt-1/PlGF比值的一致性为74.7 - 78%。预测任何先兆子痫的曲线下面积（AUC）为0.70 - 0.75，预测早产先兆子痫的AUC为0.92 - 0.99。我们发现异常的PlGF或sFlt-1/PlGF比值与子宫动脉多普勒异常之间存在显著关联（χ² = 5.47，p = 0.019），但与血小板对阿司匹林的反应无关联（χ² = 0.12，p = 0.913）。阿司匹林依从性欠佳与血管生成标志物异常或子宫动脉多普勒异常之间均无关联（χ²分别为0.144、0.038，p = 0.704、0.846）。
结论
PlGF检测之间一致性良好，PlGF检测与sFlt-1/PlGF比值之间一致性有限。所有检测对早产先兆子痫均有较高的预测准确性。异常的PlGF或sFlt-1/PlGF比值与子宫动脉多普勒异常有关，但与血小板对阿司匹林的反应无关。
Zotero 插件