Department of Biochemistry, Nantes University Hospital, France.
Department of Gynecology and Obstetrics, Nantes University Hospital, Nantes, France.
Ann Lab Med. 2018 Mar;38(2):95-101. doi: 10.3343/alm.2018.38.2.95.
Management of pregnant women at high risk of pre-eclampsia (PE) requires frequent monitoring, with referral to specialized perinatal care centers. Reliable tests are necessary to improve prediction of PE and related complications and to assess disease severity and progression. An imbalance in two biomarkers, soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF), is involved in PE pathogenesis. The sFlt-1 to PlGF ratio is increased in pregnant women before the onset of PE. An elevated ratio is highly predictive of PE, whereas the diagnosis of PE can be ruled out within one week for low ratios. The main objective of this study was to assess whether a low sFlt-1/PlGF ratio, below a cutoff of 38, can predict the absence of PE within one week.
We performed a prospective, monocentric, observational study to evaluate serum sFlt-1/PlGF ratio (Roche Diagnostics Cobas e411 system) for predicting -PE in a group of 67 high-risk pregnant women (20-37 gestation weeks).
Among the 67 patients included, 53 had a sFlt-1/PlGF ratio lower than 38; none developed subsequent PE leading to a negative predictive value of 100%. Eight patients developed clinical PE. The positive predictive value was 21% at one week and 18% at four weeks, in accordance with previous studies.
The serum sFlt-1/PlGF ratio showed highly predictive performances for ruling out PE. Using these biomarkers in routine management of PE may improve clinical care and avoid inappropriate hospitalization, which has a significant economic impact.
子痫前期（PE）高危孕妇的管理需要频繁监测，并转至专门的围产期护理中心。需要可靠的测试来提高对 PE 及相关并发症的预测能力，并评估疾病的严重程度和进展。两种生物标志物（可溶性 fms 样酪氨酸激酶 1（sFlt-1）和胎盘生长因子（PlGF））的失衡与 PE 的发病机制有关。在 PE 发病前，孕妇的 sFlt-1/PlGF 比值升高。比值升高高度提示存在 PE，而比值较低则可在一周内排除 PE 的诊断。本研究的主要目的是评估 sFlt-1/PlGF 比值是否低于 38（cutoff 值）是否可预测一周内无 PE。
我们进行了一项前瞻性、单中心、观察性研究，以评估 67 名高危孕妇（20-37 孕周）的血清 sFlt-1/PlGF 比值（罗氏诊断 Cobas e411 系统）预测 PE 的能力。
在 67 名纳入患者中，有 53 名患者的 sFlt-1/PlGF 比值低于 38，无一例随后发生导致阴性预测值为 100%的 PE。8 名患者发生临床 PE。一周和四周时的阳性预测值分别为 21%和 18%，与以往研究一致。
血清 sFlt-1/PlGF 比值对排除 PE 具有高度预测性能。在 PE 的常规管理中使用这些生物标志物可能会改善临床护理并避免不必要的住院治疗，从而产生重大的经济影响。
