Stolz Myriam, Zeisler Harald, Heinzl Florian, Binder Julia, Farr Alex
Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria.
Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria.
Pregnancy Hypertens. 2018 Jan;11:54-60. doi: 10.1016/j.preghy.2018.01.001. Epub 2018 Jan 2.
The ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) is increased in preeclampsia. This study evaluated perinatal outcomes in cases with an sFlt-1:PlGF ratio above 655.
We retrospectively analyzed data from all consecutive women with singleton pregnancies who presented with clinically manifest preeclampsia and underwent immediate sFlt-1:PlGF assessment. Cases with an sFlt-1:PlGF ratio ≥ 655 were matched 1:1 for gestational age to controls with a ratio < 655.
The 5-min Apgar score and the arterial cord pH.
There was a significant association of sFlt-1:PlGF ratios ≥ 655 with fetal distress (40% in cases vs. 3.3% in controls; p < .01) and neonatal sepsis (23.3% vs. 0%; p = .02), but not with impaired Apgar score (9 vs. 9 at 5 min; p = .45) or lower arterial cord pH (7.24 ± 0.09 vs. 7.26 ± 0.08; p = .73). Perinatal mortality (20% vs. 16.7%; p = .9), intrauterine growth restriction (IUGR; 30% vs. 13.3%; p = .2), and small-for-gestational-age fetuses (SGA; 30% vs. 16.7%; p = .35) were proportionally distributed among cases and controls. IUGR and SGA diagnoses were most common in cases with sFlt1:PlGF ratios ≥ 1000, as was respiratory distress.
An sFlt-1:PlGF ratio above 655 is not predictive of impaired perinatal outcomes, and insufficiently reliable for predicting outcomes in cases with clinical signs of preeclampsia. Our data suggest that an extremely high sFlt-1:PlGF ratio above 1000 might be more useful.
子痫前期患者中可溶性fms样酪氨酸激酶1（sFlt-1）与胎盘生长因子（PlGF）的比值升高。本研究评估了sFlt-1:PlGF比值高于655的病例的围产期结局。
我们回顾性分析了所有连续单胎妊娠且出现临床症状性子痫前期并立即进行sFlt-1:PlGF评估的女性的数据。将sFlt-1:PlGF比值≥655的病例与比值<655的对照组按孕周1:1匹配。
5分钟阿氏评分和脐动脉血pH值。
sFlt-1:PlGF比值≥655与胎儿窘迫（病例组为40%，对照组为3.3%；p<0.01）和新生儿败血症（23.3% vs. 0%；p = 0.02）显著相关，但与阿氏评分受损（5分钟时均为9分；p = 0.45）或脐动脉血pH值降低（7.24±0.09 vs. 7.26±0.08；p = 0.73）无关。围产期死亡率（20% vs. 16.7%；p = 0.9）、胎儿生长受限（FGR；30% vs. 13.3%；p = 0.2）和小于胎龄儿（SGA；30% vs. 16.7%；p = 0.35）在病例组和对照组中的分布比例相当。FGR和SGA诊断在sFlt1:PlGF比值≥1000的病例中最为常见，呼吸窘迫也是如此。
sFlt-1:PlGF比值高于655并不能预测围产期结局受损，对于预测有子痫前期临床症状病例的结局可靠性不足。我们的数据表明，高于1000的极高sFlt-1:PlGF比值可能更有用。
