Wataganara Tuangsit, Leetheeragul Jarunee, Pongprasobchai Suchittra, Sutantawibul Anuwat, Phatihattakorn Chayawat, Angsuwathana Surasak
Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.
J Obstet Gynaecol Res. 2018 May;44(5):813-830. doi: 10.1111/jog.13599. Epub 2018 Feb 14.
The benefit of the early administration of aspirin to reduce preterm pre-eclampsia among screened positive European women from multivariate algorithmic approach (ASPRE trial) has opened an intense debate on the feasibility of universal screening. This review aims to assess the new perspectives in the combined screening of pre-eclampsia in the first trimester of pregnancy and the chances for prevention using low-dose aspirin with special emphasis on the particularities of the Asian population. PubMed, CENTRAL and Embase databases were searched from inception until 15 November 2017 using combinations of the search terms: preeclampsia, Asian, prenatal screening, early prediction, ultrasonography, pregnancy, biomarker, mean arterial pressure, soluble fms-like tyrosine kinase-1, placental growth factor, pregnancy-associated plasma protein-A and pulsatility index. This is not a systematic review or meta-analysis, so the risk of bias of the selected published articles and heterogeneity among the studies need to be considered. The prevalence of pre-eclampsia and serum levels of biochemical markers in Asian are different from Caucasian women; hence, Asian ethnicity needs to be corrected for in the algorithmic assessment of multiple variables to improve the screening performance. Aspirin prophylaxis may still be viable in Asian women, but resource implication needs to be considered. Asian ethnicity should be taken into account before implementing pre-eclampsia screening strategies in the region. The variables included can be mixed and matched to achieve an optimal performance that is appropriate for economical restriction in individual countries.
从多变量算法方法来看，对筛查呈阳性的欧洲女性早期使用阿司匹林以降低早发型子痫前期的获益（ASPRE试验）引发了关于普遍筛查可行性的激烈辩论。本综述旨在评估妊娠早期子痫前期联合筛查的新观点以及使用低剂量阿司匹林进行预防的可能性，特别强调亚洲人群的特殊性。从数据库建立至2017年11月15日，使用以下检索词组合在PubMed、CENTRAL和Embase数据库中进行检索：子痫前期、亚洲、产前筛查、早期预测、超声检查、妊娠、生物标志物、平均动脉压、可溶性fms样酪氨酸激酶-1、胎盘生长因子、妊娠相关血浆蛋白-A和搏动指数。这并非一项系统综述或荟萃分析，因此需要考虑所选已发表文章的偏倚风险以及研究之间的异质性。亚洲子痫前期的患病率和生化标志物的血清水平与白人女性不同；因此，在多变量算法评估中需要校正亚洲种族因素，以提高筛查性能。阿司匹林预防在亚洲女性中可能仍然可行，但需要考虑资源问题。在该地区实施子痫前期筛查策略之前，应考虑亚洲种族因素。所纳入的变量可以进行混合和匹配，以实现适合各个国家经济限制的最佳性能。
