Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
J Matern Fetal Neonatal Med. 2021 Nov;34(22):3775-3781. doi: 10.1080/14767058.2021.1949277. Epub 2021 Jul 8.
Preeclampsia is one of the leading causes of maternal-neonatal morbidity and mortality, especially in developed and developing countries. Incidence of preeclampsia differs in accordance with parity, race, age, geography, and concomitant diseases. The role of placental implantation and risk factors was elucidated precisely. Antenatal care, use of medications, change in lifestyle, and nutritional supplementation were investigated for the prevention or decrease the complications; however, to date, there has not exposed a proper approach for prevention and prediction. The trigger mechanism or circumstance is still debate. Placental development especially spiral artery remodeling might be supposed to be the accused primary site of preeclampsia. Extracellular matrix proteins play a crucial role in implantation. Fibulin is one of these proteins which represents an association with matrix proteins, basement membranes, and elastic fibers. Fibulins are mainly functioning in the remodeling of tissues especially blood vessels, endocardial cushion, the mesenchymal, and connective tissue of several organs including heart, lung, intestine, kidneys, and liver. Several diseases were associated with altered fibulin levels. We aimed to examine fibulin-1 levels in preeclamptic patients and to focus on the possible role of fibulin-1 in preeclampsia.
A prospective observational, case-control study was achieved. Patients diagnosed with preeclampsia and healthy controls were recruited in the study. Patients' demographic features, perinatal outcomes, complications, obstetrics doppler ultrasonographic evaluations, laboratory results, and serum fibulin-1 levels were reviewed. The comparison of the groups was determined statistically. Correlation analysis and multivariate logistic analysis were calculated. The receiver operating characteristic (ROC) curve was used to indicate fibulin-1 levels for the prediction of preeclampsia.
A total of 36 healthy pregnant and 38 preeclamptic patients were included in the study. Comparison of the groups with age, gravidity, BMI, APGAR scores, birth weight did not differ significantly. Kidney and liver function tests and complete hemogram parameters did not have a clinically important difference. Fibulin-1 levels were significantly lower in patients with preeclampsia. The ROC curve for fibulin-1 for predicting the preeclampsia risk was analyzed. The area under the ROC curves was 0.682 (95% CI [0.560-0.804, < .007) for fibulin-1. The optimal cutoff value of fibulin-1 for detecting preeclampsia was ≤ 27.81 ng/ml, at which the sensitivity was 61.1% and specificity was 63.2 %.
Fibulin-1 levels could be a beneficial marker for preeclampsia diagnosis and prediction. It might have a role in the etiopathology of preeclampsia, due to its function in the extracellular matrix.
评估血清纤维连接蛋白-1（fibulin-1）水平在子痫前期患者中的变化，探讨其在子痫前期发病机制中的作用。
采用前瞻性观察性病例对照研究方法，选取子痫前期患者 38 例和同期正常孕妇 36 例，记录患者的一般资料、围生期结局、并发症、产科超声多普勒检查、实验室检查结果及血清 fibulin-1 水平，采用统计学方法进行组间比较，分析相关性，采用多因素 logistic 回归分析进行危险因素分析，应用受试者工作特征（ROC）曲线评价血清 fibulin-1 水平对预测子痫前期的价值。
两组孕妇年龄、体质量指数（BMI）、孕次、新生儿 1 分钟 Apgar 评分、新生儿出生体质量比较差异均无统计学意义（P>0.05）。两组孕妇肝肾功能、血常规参数比较差异均无统计学意义（P>0.05）。子痫前期组患者血清 fibulin-1 水平显著低于对照组（P<0.05）。ROC 曲线分析显示，血清 fibulin-1 预测子痫前期的曲线下面积为 0.682（95%CI：0.560～0.804，P<0.007）。血清 fibulin-1 预测子痫前期的最佳截断值为≤27.81 ng/ml，此时其诊断子痫前期的敏感度为 61.1%，特异度为 63.2%。
血清 fibulin-1 水平可能与子痫前期的发病相关，可作为子痫前期的诊断及预测指标。
