Department of Women and Children's Health, King's College London, London, United Kingdom; Department of Renal Medicine, Barts Health NHS Trust, United Kingdom.
Department of Women and Children's Health, King's College London, London, United Kingdom; Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom.
Pregnancy Hypertens. 2021 Jun;24:58-64. doi: 10.1016/j.preghy.2021.02.010. Epub 2021 Feb 23.
To evaluate PlGF, sFlt-1, and novel endothelial biomarkers hyaluronan and vascular cell adhesion molecule (VCAM), for the prediction of superimposed pre-eclampsia in women with chronic kidney disease (CKD).
Prospective cohort study of pregnant women with CKD in UK.
Outcomes including superimposed pre-eclampsia were based on predetermined criteria. Test performances of plasma PlGF, serum sFlt-1:PlGF, hyaluronan and VCAM concentrations were evaluated as area under the receiver-operating curve and at established and exploratory threshold concentrations.
There were 232 pregnancies in 221 women with CKD. One third (76/232) developed superimposed pre-eclampsia. From 21 to 37 weeks' gestation, plasma PlGF was decreased among women that developed superimposed preeclampsia. Plasma PlGF levels < 150 pg/ml had the highest sensitivity (79% 95% CI: 58-91%) and negative predictive value (97%, 95% CI: 93-99%) for the prediction of delivery with superimposed pre-eclampsia within 14 days. Predictive performances of hyaluronan and VCAM were lower than for plasma PlGF. Low plasma PlGF, high hyaluronan and high VCAM concentrations had lower predictive performance in women with pre-pregnancy CKD stages 3-5 compared to stages 1-2. sFlt-1:PlGF > 38 did not usefully predict the need to deliver in women with CKD when measured in serum.
Increased surveillance for the need for delivery should take place in women with CKD and plasma PlGF below 150 pg/ml after 20 weeks' gestation, with awareness that predictive value is reduced as excretory kidney function declines. Maternal endothelial dysfunction may alter the PlGF threshold at which superimposed pre-eclampsia manifests in women with CKD.
评估胎盘生长因子（PlGF）、可溶性血管内皮生长因子受体 1（sFlt-1）和新型内皮生物标志物透明质酸（hyaluronan）及血管细胞黏附分子（VCAM）在预测慢性肾脏病（CKD）孕妇并发子痫前期中的作用。
英国 CKD 孕妇前瞻性队列研究。
根据预先设定的标准评估包括子痫前期在内的结局。采用受试者工作特征曲线下面积及既定和探索性临界值浓度评估血浆 PlGF、血清 sFlt-1/PlGF、透明质酸和 VCAM 浓度的检测性能。
共纳入 221 例 CKD 孕妇的 232 例妊娠，其中 1/3（76/232）发生了子痫前期。2137 孕周时，发生子痫前期的孕妇血浆 PlGF 降低。血浆 PlGF 水平<150 pg/ml 对预测 14 天内发生子痫前期的敏感度最高（79%，95%CI：5891%），阴性预测值最高（97%，95%CI：9399%）。透明质酸和 VCAM 的预测性能均低于血浆 PlGF。与 CKD 孕前 12 期患者相比，孕前 3~5 期患者血浆 PlGF 降低、透明质酸和 VCAM 升高时预测效能更低。在 CKD 孕妇中，血清 sFlt-1/PlGF>38 并不能有效预测是否需要分娩。
对于 CKD 孕妇，20 孕周后如果血浆 PlGF 水平<150 pg/ml，应加强对分娩需求的监测，而随着肾功能下降，预测值会降低。母体血管内皮功能障碍可能会改变 CKD 孕妇并发子痫前期时的 PlGF 临界值。
