Department of Obstetrics, University Hospital Leipzig, Leipzig, Germany.
Department of Obstetrics, University Hospital Leipzig, Leipzig, Germany.
Am J Obstet Gynecol. 2022 Feb;226(2S):S1037-S1047.e2. doi: 10.1016/j.ajog.2020.10.028. Epub 2021 Apr 20.
In routine clinical practice, angiogenic factor measurement can facilitate prediction and diagnosis of preeclampsia and other manifestations of placental dysfunction (eg, intrauterine growth restriction).
This real-world data analysis investigated the utility of soluble fms-like tyrosine kinase-1 and placental growth factor for preeclampsia and placental dysfunction.
Blood serum soluble fms-like tyrosine kinase-1 and placental growth factor were measured using Elecsys soluble fms-like tyrosine kinase-1 and placental growth factor immunoassays (cobas e analyzer; Roche Diagnostics). Overall, 283 unselected singleton pregnancies with ≥1 determination of soluble fms-like tyrosine kinase-1-to-placental growth factor ratio were included. Distribution of the ratio at admission was normal (<38 [58.7%]), intermediate (38-85/110 [19.1%]), or pathologic (>85/110 [22.3%]). Overall, 15.5% had preeclampsia or hemolysis, elevated liver enzyme levels, and low platelet count, and 15.5% of women had intrauterine growth restriction.
Increasing soluble fms-like tyrosine kinase-1-to-placental growth factor ratio was associated with an increase in priority of delivery (r=0.38; P<.001). The percentage of patients who developed preeclampsia by soluble fms-like tyrosine kinase-1-to-placental growth factor ratio at admission was 5.4% (normal), 7.4% (intermediate), and 49.2% (pathologic). The greatest difference in soluble fms-like tyrosine kinase-1-to-placental growth factor ratio from admission to birth occurred in pathologic pregnancies (171.12 vs 39.84 for normal pregnancies). Soluble fms-like tyrosine kinase-1-to-placental growth factor ratio correlated inversely with gestational age at delivery, birthweight, and prolongation time. There was no significant relation between the prolongation period or the gestational age at first determination to the increase of soluble fms-like tyrosine kinase-1 and placental growth factor between admission and delivery (ΔQ). This analysis used a real-world approach to investigate the clinical utility of the soluble fms-like tyrosine kinase-1-to-placental growth factor ratio in placental dysfunction.
Confirming the results of prospective studies, we observed a positive correlation between soluble fms-like tyrosine kinase-1-to-placental growth factor ratio and severity of placental dysfunction and a negative association with time to delivery. In a real-world setting, the soluble fms-like tyrosine kinase-1-placental growth factor ratio stratifies patients with normal outcome and outcome complicated by placental dysfunction.
在常规临床实践中，血管生成因子的测量有助于预测和诊断子痫前期和胎盘功能障碍的其他表现（例如，宫内生长受限）。
本真实数据分析旨在研究可溶性 fms 样酪氨酸激酶-1（sFlt-1）和胎盘生长因子（PlGF）在子痫前期和胎盘功能障碍中的应用。
采用 Elecsys sFlt-1 和 PlGF 免疫测定法（cobas e 分析仪；罗氏诊断公司）检测血清可溶性 fms 样酪氨酸激酶-1（sFlt-1）和胎盘生长因子。共纳入 283 例未经选择的单胎妊娠，至少有 1 次可溶性 fms 样酪氨酸激酶-1 与胎盘生长因子比值（sFlt-1/PlGF）的测定。入院时比值的分布呈正态分布（<38 [58.7%]）、中间分布（38-85/110 [19.1%]）或病理分布（>85/110 [22.3%]）。总体而言，15.5%的患者患有子痫前期或溶血性肝酶升高和血小板减少症，15.5%的患者患有宫内生长受限。
可溶性 fms 样酪氨酸激酶-1 与胎盘生长因子比值的增加与分娩时机的提前呈正相关（r=0.38；P<.001）。入院时可溶性 fms 样酪氨酸激酶-1 与胎盘生长因子比值的子痫前期发生率分别为 5.4%（正常）、7.4%（中间）和 49.2%（病理）。病理妊娠的可溶性 fms 样酪氨酸激酶-1 与胎盘生长因子比值从入院到分娩的变化最大（正常妊娠为 171.12，病理妊娠为 39.84）。可溶性 fms 样酪氨酸激酶-1 与胎盘生长因子比值与分娩时的胎龄、出生体重和延长时间呈负相关。入院至分娩时可溶性 fms 样酪氨酸激酶-1 和胎盘生长因子的增加与入院时到首次测定时的延长时间或胎龄之间没有显著关系（ΔQ）。本分析采用真实世界的方法研究了可溶性 fms 样酪氨酸激酶-1 与胎盘生长因子比值在胎盘功能障碍中的临床应用。
与前瞻性研究的结果一致，我们观察到可溶性 fms 样酪氨酸激酶-1 与胎盘生长因子比值与胎盘功能障碍的严重程度呈正相关，与分娩时间呈负相关。在真实环境中，可溶性 fms 样酪氨酸激酶-1 与胎盘生长因子比值将具有正常结局和伴有胎盘功能障碍结局的患者分层。
