de Jesús Guilherme R, Lacerda Marcela I, Rodrigues Bruna C, Dos Santos Flávia C, do Nascimento Adriana P, Cristóvão Porto Luís, de Jesús Nilson R, Levy Roger A, Klumb Evandro M
Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
GlaxoSmithKline, Upper Providence, Pennsylvania.
Arthritis Care Res (Hoboken). 2021 May;73(5):717-721. doi: 10.1002/acr.24360. Epub 2021 Apr 3.
To evaluate mean serum levels of vascular endothelial growth factor (VEGF), placental growth factor (PlGF), and soluble Flt-1 (sFlt-1) in pregnant patients with systemic lupus erythematosus (SLE) with inactive disease, active lupus nephritis, and preeclampsia for differential diagnosis between these conditions.
Pregnant women with SLE, with singleton pregnancies and no other autoimmune diseases, were classified according to disease activity (inactive SLE and active lupus nephritis) and the presence of preeclampsia. Serum samples were collected within 3 weeks of delivery and frozen for subsequent blinded analysis through the enzyme-linked immunosorbent assay method.
A total of 71 women were included, with 41 classified as having inactive SLE (group 1; Systemic Lupus Erythematosus Pregnancy Disease Activity Index [SLEPDAI] score <4), 15 with a diagnosis of active lupus nephritis (group 2, SLEPDAI score ≥4, including renal criteria), and 15 with a diagnosis of preeclampsia (group 3). Patients in group 3 had higher mean levels of sFlt-1 and lower mean levels of PlGF compared to groups 1 and 2, both findings with statistical significance. The sFlt-1:PlGF ratio was also significantly higher in patients with preeclampsia, while mean VEGF levels were higher in pregnant woman with active lupus nephritis compared to patients with preeclampsia or inactive SLE.
Evaluation of serum VEGF, PlGF, and sFlt-1 levels can differentiate between preeclampsia, inactive SLE, and active lupus nephritis during pregnancy.
评估患有系统性红斑狼疮（SLE）的孕妇在疾病非活动期、活动性狼疮性肾炎和先兆子痫时血管内皮生长因子（VEGF）、胎盘生长因子（PlGF）和可溶性Flt-1（sFlt-1）的血清平均水平，以对这些情况进行鉴别诊断。
单胎妊娠且无其他自身免疫性疾病的SLE孕妇，根据疾病活动度（非活动期SLE和活动性狼疮性肾炎）和先兆子痫的存在进行分类。在分娩后3周内采集血清样本并冷冻，随后通过酶联免疫吸附测定法进行盲法分析。
共纳入71名女性，其中41名被分类为患有非活动期SLE（第1组；系统性红斑狼疮妊娠疾病活动指数[SLEPDAI]评分<4），15名诊断为活动性狼疮性肾炎（第2组，SLEPDAI评分≥4，包括肾脏标准），15名诊断为先兆子痫（第3组）。与第1组和第2组相比，第3组患者的sFlt-1平均水平较高，PlGF平均水平较低，这两项结果均具有统计学意义。先兆子痫患者的sFlt-1:PlGF比值也显著更高，而活动性狼疮性肾炎孕妇的VEGF平均水平高于先兆子痫或非活动期SLE患者。
评估血清VEGF、PlGF和sFlt-1水平可在孕期鉴别先兆子痫、非活动期SLE和活动性狼疮性肾炎。
