Boulanger Henri, Lefèvre Guillaume, Ahriz Saksi Salima, Achiche Jedjiga, Bailleul Sophie, Ekoukou Dieudonné, Drouin Dominique, Sault Corinne, Stawiarski Nicolas, Dupuis Emmanuel
Service de néphrologie et de dialyse de la clinique de l'Estrée, 35, rue d'Amiens, 93240 Stains, France.
Service de biochimie et d'hormonologie, hôpital Tenon, HUEP, 4, rue de la Chine, 75020 Paris, France.
Nephrol Ther. 2019 Nov;15(6):413-429. doi: 10.1016/j.nephro.2018.10.005. Epub 2019 Mar 30.
The role of angiogenic factors in the onset of clinical manifestations of preeclampsia was demonstrated in 2003 by the implication of sFlt-1, PlGF and VEGF, and in 2006 by the implication of soluble endoglin. Placental ischemia and inflammation observed in preeclampsia alter both the production and progression of angiogenic factors during pregnancy. During the first trimester, the combination of PlGF with clinical, biophysical and biological factors results in a better test than the conventional one. However, the clinical value of this method remains to be confirmed. During the second and third trimesters, the sFlt-1/PlGF ratio may be used, with or without pre-existing renal disease, for short-term prediction, diagnosis, and prognosis, and to evaluate the effectiveness of preeclampsia treatment. While a sFlt-1/PlGF ratio<38 and≤33, respectively, rules out the short-term onset and diagnosis of preeclampsia, a sFlt-1/PlGF ratio≥85 between 20 and 34 weeks of pregnancy and≥110 beyond 34 weeks of pregnancy confirms a diagnosis of preeclampsia. Angiogenic and non-angiogenic preeclampsia are identified by a sFlt-1PlGF≥85 and<85, respectively, with the risk of maternal and fetal complications at two weeks differing between the two. Similarly, a sFlt-1/PlGF ratio>665 and>205, respectively, is a good short-term predictor of adverse outcomes of early and late-onset preeclampsia. These values could be incorporated into future guidelines for better clinical management of preeclampsia.
2003年，sFlt-1、胎盘生长因子（PlGF）和血管内皮生长因子（VEGF）参与子痫前期的过程，证明了血管生成因子在子痫前期临床表现发作中的作用；2006年，可溶性内皮糖蛋白的参与也证明了这一点。子痫前期中观察到的胎盘缺血和炎症会改变孕期血管生成因子的产生和进程。在孕早期，PlGF与临床、生物物理和生物学因素相结合的检测方法比传统方法更好。然而，这种方法的临床价值仍有待证实。在孕中期和孕晚期，无论是否存在肾脏疾病，sFlt-1/PlGF比值都可用于短期预测、诊断和预后评估，以及评估子痫前期治疗的效果。虽然sFlt-1/PlGF比值分别<38和≤33可排除子痫前期的短期发作和诊断，但妊娠20至34周时sFlt-1/PlGF比值≥85以及妊娠34周后≥110则可确诊子痫前期。血管生成性和非血管生成性子痫前期分别通过sFlt-1/PlGF≥85和<85来识别，两者在两周时母婴并发症的风险有所不同。同样，sFlt-1/PlGF比值分别>665和>205是早发型和晚发型子痫前期不良结局的良好短期预测指标。这些数值可纳入未来指南，以更好地对子痫前期进行临床管理。
