胎盘生长因子与不良母婴结局的风险。
Placental Growth Factor and the Risk of Adverse Neonatal and Maternal Outcomes.
机构信息
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), and the Department of Cancer Biology, Metastasis Research Center, University of Texas MD Anderson Cancer Center, Houston, Texas; and Baptist Health Lexington, Lexington, Kentucky.
出版信息
Obstet Gynecol. 2020 Mar;135(3):665-673. doi: 10.1097/AOG.0000000000003694.
OBJECTIVE
To evaluate whether abnormal plasma placental growth factor (PlGF) level is associated with adverse neonatal and maternal outcomes.
METHODS
This was a secondary analysis of the Preeclampsia Triage by Rapid Assay Trial (PETRA), a prospective, multicenter, observational study that enrolled women with suspected preeclampsia. Our analysis included women age 18-45 years with a singleton pregnancy between 20 and 41 weeks of gestation. Plasma collected at enrollment was used for PlGF measurement. Abnormal PlGF was defined as low (100 pg/mL or less) or very low (less than 12 pg/mL). The primary outcomes were composite adverse neonatal and maternal outcomes. We used multivariable Poisson regression models to examine the association between PlGF and outcomes.
RESULTS
Of 1,112 women who met the inclusion criteria, plasma PlGF was low in 742 (67%) and very low in 353 (32%). In the cohort, the overall rates of the composite adverse neonatal and maternal outcomes were 6.4% and 4.8%, respectively. Compared with normal PlGF (more than 100 pg/mL), low PlGF was significantly associated with an increased risk of the composite neonatal outcome (9.2% vs 0.8%; adjusted relative risk [aRR] 17.2, 95% CI 5.2-56.3), and the composite maternal outcome (6.2% vs 1.9%; aRR 3.6, 95% CI 1.7-8.0). Very low PlGF was also significantly associated with both neonatal and maternal outcomes. The sensitivity and specificity of low PlGF were 95.8% and 35.3%, respectively, for the composite neonatal outcome, and 86.8% and 34.3% for the composite maternal outcome. Although the positive predictive values were low (9.2% and 6.2%, respectively), the negative predictive value of low PlGF for neonatal and maternal outcomes was 99.2% and 98.1%, respectively.
CONCLUSION
Among women being evaluated for preeclampsia, those with abnormal PlGF are significantly more likely to experience adverse neonatal and maternal outcomes. These outcomes occur infrequently when the PlGF is normal. These findings suggest that PlGF may be useful for risk stratification of women with suspected preeclampsia.
FUNDING SOURCE
No funding was received for this study. The original PETRA study was supported by funding from Alere.
目的
评估异常血浆胎盘生长因子（PlGF）水平是否与不良母婴结局相关。
方法
这是一项通过快速检测试验（PETRA）评估子痫前期的二级分析，是一项前瞻性、多中心、观察性研究，纳入了疑似子痫前期的女性。我们的分析包括年龄在 18-45 岁之间、妊娠 20-41 周单胎妊娠的女性。入组时采集的血浆用于 PlGF 测量。异常 PlGF 定义为低（<100pg/mL）或极低（<12pg/mL）。主要结局是复合不良母婴结局。我们使用多变量泊松回归模型来检验 PlGF 与结局之间的关系。
结果
在符合纳入标准的 1112 名女性中，742 名（67%）的 PlGF 水平较低，353 名（32%）的 PlGF 水平极低。在该队列中，复合不良母婴结局的总发生率分别为 6.4%和 4.8%。与正常 PlGF（>100pg/mL）相比，低 PlGF 与新生儿复合结局风险增加显著相关（9.2% vs 0.8%；调整后相对风险 [aRR] 17.2，95%CI 5.2-56.3），以及产妇复合结局（6.2% vs 1.9%；aRR 3.6，95%CI 1.7-8.0）。极低 PlGF 也与新生儿和产妇结局显著相关。低 PlGF 对新生儿复合结局的敏感性和特异性分别为 95.8%和 35.3%，对产妇复合结局的敏感性和特异性分别为 86.8%和 34.3%。虽然阳性预测值较低（分别为 9.2%和 6.2%），但低 PlGF 对新生儿和产妇结局的阴性预测值分别为 99.2%和 98.1%。
结论
在接受子痫前期评估的女性中，PlGF 异常者发生不良母婴结局的风险显著更高。当 PlGF 正常时，这些结局很少发生。这些发现表明 PlGF 可能对疑似子痫前期的女性进行风险分层有用。
资助来源
本研究无资金支持。最初的 PETRA 研究由 Alere 资助。
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