评估 sFlt-1/PlGF 比值在早发型子痫前期中的预后价值。

Evaluation of the Prognostic Value of the sFlt-1/PlGF Ratio in Early-Onset Preeclampsia.

机构信息

Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France.

Department of Biochemistry and Hormonology, Paul Sabatier University, Toulouse, France.

出版信息

Am J Perinatol. 2021 Aug;38(S 01):e292-e298. doi: 10.1055/s-0040-1709696. Epub 2020 May 23.

DOI:10.1055/s-0040-1709696

PMID:32446261

Abstract

OBJECTIVE

Increased expression of soluble fms-like tyrosine kinase 1 (sFlt-1), associated with a decrease in placental growth factor (PlGF), plays a key role in the pathogenesis of preeclampsia (PE). We evaluated the prognostic value of the sFlt-1/PlGF ratio for the onset of adverse maternofetal outcomes (AMFO) in case of early-onset PE with attempted expectant management.

STUDY DESIGN

From October 2016 through November 2018, all singleton pregnancies complicated by early-onset PE (before 34 weeks of gestation) were included in a cohort study. The plasma levels of sFlt-1 and PlGF were blindly measured on admission. For the statistical analysis, we performed a bivariate analysis, a comparison of the receiving operating characteristic curves and a survival analysis estimated by the Kaplan-Meier method.

RESULTS

Among 109 early PE, AMFO occurred in 87 pregnancies (79.8%), mainly hemolysis, elevated liver enzymes, and low platelet count syndrome and severe fetal heart rate abnormalities requiring urgent delivery. The area under the curve (AUC) of sFlt-1/PlGF ratio was 0.82 (95% confidence interval [CI]: 0.73-0.88) for the risk of AMFO and the difference between the AUCs was significant for each separate standard parameter ( = 0.018 for initial diastolic blood pressure, = 0.013 for alanine aminotransferase, < 0.001 for uric acid). Pregnancies were best classified by a cutoff ratio of 293, with a sensitivity of 95% and a specificity of 50%. With a ratio value less than 293, no pregnancy was complicated or had been stopped during the first 5 days. A ratio more than 293 was associated with an increased risk of AMFO onset (hazard ratio [HR]: 3.61; 95% CI: 2.13-6.10; < 0.001) and had a significant association with the length of time between the diagnosis of PE and delivery (HR: 2.49; 95% CI: 1.56-3.96; < 0.001).

CONCLUSION

The sFlt-1/PlGF ratio is an additional tool in the prediction of AMFO in proven early-onset PE, which is likely to improve care by anticipating severe complications.

KEY POINTS

· The sFlt-1/PlGF ratio is associated with AMFO.. · It is an additional tool for physician.. · We proposed a 293 cutoff value for the ratio..

摘要

目的

可溶性 fms 样酪氨酸激酶 1（sFlt-1）的表达增加，与胎盘生长因子（PlGF）的减少有关，在子痫前期（PE）的发病机制中起关键作用。我们评估了 sFlt-1/PlGF 比值在尝试期待治疗的早发型 PE 中发生不良母婴结局（AMFO）的预后价值。

研究设计

从 2016 年 10 月至 2018 年 11 月，所有患有早发型 PE（妊娠 34 周前）的单胎妊娠均纳入队列研究。入院时盲法检测 sFlt-1 和 PlGF 的血浆水平。进行了双变量分析、接收者操作特征曲线比较和 Kaplan-Meier 方法估计的生存分析。

结果

在 109 例早发性 PE 中，87 例（79.8%）发生 AMFO，主要为溶血、肝酶升高和血小板计数降低综合征以及严重胎心率异常需要紧急分娩。sFlt-1/PlGF 比值的曲线下面积（AUC）为 0.82（95%置信区间[CI]：0.73-0.88），用于 AMFO 的风险，每个单独的标准参数之间的 AUC 差异均有统计学意义（=0.018 用于初始舒张压，=0.013 用于丙氨酸氨基转移酶，<0.001 用于尿酸）。妊娠最好通过 293 的截断比来分类，其敏感性为 95%，特异性为 50%。比值小于 293 时，前 5 天无妊娠并发症或停止。比值大于 293 与 AMFO 发作的风险增加相关（风险比[HR]：3.61；95%CI：2.13-6.10；<0.001），并且与 PE 诊断与分娩之间的时间长度有显著相关性（HR：2.49；95%CI：1.56-3.96；<0.001）。