Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.
Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.
Pregnancy Hypertens. 2020 Oct;22:160-166. doi: 10.1016/j.preghy.2020.09.007. Epub 2020 Sep 17.
Pregnancies of women with chronic kidney disease (CKD) are at higher risk of experiencing adverse perinatal (APO) and maternal outcome (AMO). Mean uterine artery pulsatility index (mUtA-PI) as well as the ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are helpful tools in diagnosing pre-eclampsia (PE) in women with CKD. The aim of the study was to evaluate the role of sFlt-1/PIGF ratio and mUtA-PI as predictors for APO, AMO, preterm delivery and decline of kidney function in CKD pregnancies.
A total of 28 CKD pregnancies with suspected PE/HELLP syndrome were retrospectively included, in whom both sFlt-1/PIGF and mUtA-PI were determined during the third trimester. APO was defined as fetal growth restriction, respiratory distress syndrome, intubation, admission to NICU, 5 min Apgar <7 and intracerebral hemorrhage. AMO was defined as the development of PE, HELLP syndrome or resistant hypertension. Decline of kidney function was defined as a 25% increase of creatinine level after delivery.
Of all included women, eight (28.6%) developed a PE/HELLP syndrome. AMO (28.6%) and APO (32.1%) were frequently observed. ROC analyses revealed a predictive value for AMO and sFlt-1/PIGF or mUtA-PI. Neither sFlt-1/PIGF nor mUtA-PI could predict APO or decline of postnatal kidney function. mUtA-PI was a predictor for preterm delivery.
Uterine Doppler and sFlt-1/PIGF are predictors of AMO in CKD pregnancies. Therefore, both markers might be helpful for an improved risk assessment. However, neither sFlt-1/PIGF nor mUtA-PI were able to predict a decline of postnatal kidney function or APO.
患有慢性肾脏病（CKD）的女性的妊娠面临更高的围产期不良结局（APO）和产妇结局（AMO）风险。平均子宫动脉搏动指数（mUtA-PI）以及可溶性 fms 样酪氨酸激酶-1（sFlt-1）与胎盘生长因子（PlGF）的比值有助于诊断 CKD 女性的子痫前期（PE）。本研究旨在评估 sFlt-1/PlGF 比值和 mUtA-PI 作为预测 CKD 妊娠 APO、AMO、早产和肾功能下降的指标的作用。
回顾性纳入 28 例疑似 PE/HELLP 综合征的 CKD 妊娠，其中在妊娠晚期均测定了 sFlt-1/PlGF 和 mUtA-PI。APO 定义为胎儿生长受限、呼吸窘迫综合征、插管、入住新生儿重症监护病房、5 分钟 Apgar 评分<7 和颅内出血。AMO 定义为 PE、HELLP 综合征或难治性高血压的发生。肾功能下降定义为产后肌酐水平升高 25%。
所有纳入的女性中，有 8 例（28.6%）发生了 PE/HELLP 综合征。常观察到 AMO（28.6%）和 APO（32.1%）。ROC 分析显示 AMO 和 sFlt-1/PlGF 或 mUtA-PI 具有预测价值。sFlt-1/PlGF 和 mUtA-PI 均不能预测 APO 或产后肾功能下降。mUtA-PI 是早产的预测因素。
子宫动脉多普勒和 sFlt-1/PlGF 是 CKD 妊娠 AMO 的预测指标。因此，这两种标志物可能有助于改善风险评估。然而，sFlt-1/PlGF 和 mUtA-PI 均不能预测产后肾功能下降或 APO。
