Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK.
Ankara University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
Ultrasound Obstet Gynecol. 2018 Jun;51(6):731-737. doi: 10.1002/uog.19002. Epub 2018 May 3.
To determine the accuracy of ophthalmic artery Doppler in pregnancy for the prediction of pre-eclampsia (PE).
MEDLINE, EMBASE, CINAHL and The Cochrane Library were searched for relevant citations without language restrictions. Two reviewers independently selected studies that evaluated the accuracy of ophthalmic artery Doppler to predict the development of PE and extracted data to construct 2 × 2 tables. Individual patient data were obtained from the authors if available. A bivariate random-effects model was used for the quantitative synthesis of data. Logistic regression analysis was employed to generate receiver-operating characteristics (ROC) curves and obtain optimal cut-offs for each investigated parameter, and a bivariate analysis was employed using predetermined cut-offs to obtain sensitivity and specificity values and generate summary ROC curves.
A total of 87 citations matched the search criteria of which three studies, involving 1119 pregnancies, were included in the analysis. All included studies had clear description of the index and reference tests, avoidance of verification bias and adequate follow-up. Individual patient data were obtained for all three included studies. First diastolic peak velocity of ophthalmic artery Doppler at a cut-off of 23.3 cm/s showed modest sensitivity (61.0%; 95% CI, 44.2-76.1%) and specificity (73.2%; 95% CI, 66.9-78.7%) for the prediction of early-onset PE (area under the ROC curve (AUC), 0.68; 95% CI, 0.61-0.76). The first diastolic peak velocity had a much lower sensitivity (39.0%; 95% CI, 20.6-61.0%), a similar specificity (73.2%; 95% CI, 66.9-78.7%) and a lower AUC (0.58; CI, 0.52-0.65) for the prediction of late-onset PE. The pulsatility index of the ophthalmic artery did not show a clinically useful sensitivity or specificity at any cut-off for early- or late-onset PE. Peak ratio above 0.65 showed a similar diagnostic accuracy to that of the first diastolic peak velocity with an AUC of 0.67 (95% CI, 0.58-0.77) for early-onset PE and 0.57 (95% CI, 0.51-0.63) for late-onset disease.
Ophthalmic artery Doppler is a simple, accurate and objective technique with a standalone predictive value for the development of early-onset PE equivalent to that of uterine artery Doppler evaluation. The relationship between ophthalmic Doppler indices and PE cannot be a consequence of trophoblast invasion and may be related to maternal hemodynamic adaptation to pregnancy. The findings of this review justify efforts to elucidate the effectiveness and underlying mechanism whereby two seemingly unrelated maternal vessels can be used for the prediction of a disease considered a 'placental disorder'. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
确定眼动脉多普勒在妊娠中预测子痫前期（PE）的准确性。
无语言限制地检索 MEDLINE、EMBASE、CINAHL 和 The Cochrane Library 中的相关引文。两位审查员独立选择评估眼动脉多普勒预测 PE 发展准确性的研究，并提取数据构建 2×2 表格。如果有可用的个体患者数据，则从作者处获得。使用双变量随机效应模型对数据进行定量综合。使用逻辑回归分析生成受试者工作特征（ROC）曲线，并为每个研究参数获得最佳截断值，使用预定的截断值进行双变量分析以获得敏感性和特异性值，并生成汇总 ROC 曲线。
共有 87 条引文符合搜索标准，其中 3 项研究，涉及 1119 例妊娠，被纳入分析。所有纳入的研究都对指标和参考测试进行了明确的描述，避免了验证偏倚和充分的随访。所有纳入的研究均获得了个体患者数据。眼动脉多普勒的第一舒张期峰值速度在截断值为 23.3cm/s 时，对早期发病的 PE（ROC 曲线下面积（AUC），0.68；95%CI，0.61-0.76）的预测具有中等敏感性（61.0%；95%CI，44.2-76.1%）和特异性（73.2%；95%CI，66.9-78.7%）。第一舒张期峰值速度对晚期发病的 PE 预测具有较低的敏感性（39.0%；95%CI，20.6-61.0%），相似的特异性（73.2%；95%CI，66.9-78.7%）和较低的 AUC（0.58；CI，0.52-0.65）。眼动脉搏动指数在任何早期或晚期发病的截断值处均未显示出临床有用的敏感性或特异性。高于 0.65 的峰值比具有与第一舒张期峰值速度相似的诊断准确性，其 AUC 为 0.67（95%CI，0.58-0.77）用于早期发病和 0.57（95%CI，0.51-0.63）用于晚期发病。
眼动脉多普勒是一种简单、准确和客观的技术，具有与子宫动脉多普勒评估相当的早期发病 PE 发展的独立预测价值。眼动脉多普勒指数与 PE 之间的关系不可能是滋养细胞浸润的结果，可能与母体对妊娠的血液动力学适应有关。本综述的结果证明了努力阐明两种看似不相关的母体血管可用于预测被认为是“胎盘疾病”的疾病的有效性和潜在机制是合理的。版权所有©2018 ISUOG。由 John Wiley & Sons Ltd 出版。
