Gao Jinsong, Huang Xianghua, Di Wen, Dong Xiaojing, Gou Wenli, Shi Hong, Wang Zilian, Dietl Angela, Grill Sonja, Hund Martin
Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Front Cardiovasc Med. 2021 Aug 23;8:602560. doi: 10.3389/fcvm.2021.602560. eCollection 2021.
The diagnosis of preeclampsia in China currently relies on limited clinical signs and unspecific laboratory findings. These are inadequate predictors of preeclampsia development, limiting early diagnosis and appropriate management. Previously, the Prediction of Short-Term Outcome in Pregnant Women with Suspected Preeclampsia Study (PROGNOSIS) and PROGNOSIS Asia demonstrated that a soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio of ≤38 can be used to rule out preeclampsia within 1 week, with negative predictive values of 99.3 and 98.6%, respectively. This is an exploratory sub-analysis of the Chinese cohort ( = 225) of the PROGNOSIS Asia study. The primary objectives were to assess the predictive performance of using the sFlt-1/PlGF ratio to rule out preeclampsia within 1 week and to rule in preeclampsia within 4 weeks. The sFlt-1/PlGF ratio was also examined for short-term prediction of fetal adverse outcomes, maternal adverse outcomes, and time to delivery. The overall prevalence of preeclampsia was 17.3%. With the use of an sFlt-1/PlGF ratio of ≤38, the negative predictive value for ruling out preeclampsia within 1 week was 97.3% [95% confidence interval (CI), 93.8-99.1], with a sensitivity of 64.3% and specificity of 85.3%. With the use of an sFlt-1/PlGF ratio of >38, the positive predictive value for ruling in preeclampsia within 4 weeks was 35.0% (95% CI, 20.6-51.7), with a sensitivity of 50.0% and specificity of 86.8%. In the analyses of the sFlt-1/PlGF ratio and fetal adverse outcomes, the area under the receiver operating characteristic curve was 92.8% (95% CI, 83.5-98.7) for ruling out fetal adverse outcomes within 1 week and 79.9% (95% CI, 68.1-90.3) for ruling in fetal adverse outcomes within 4 weeks. An sFlt-1/PlGF ratio of >38 increased the likelihood of imminent delivery 3.3-fold compared with a ratio of ≤38 [hazard ratio, 3.3 (95% CI, 2.1-5.1)]. This sub-analysis confirms the high predictive performance of the sFlt-1/PlGF ratio cutoff of 38 for short-term prediction of preeclampsia in Chinese women, which may help prevent unnecessary hospitalization of women with low risk of developing preeclampsia.
目前，中国子痫前期的诊断依赖于有限的临床体征和非特异性的实验室检查结果。这些对于子痫前期的发展而言是不充分的预测指标，限制了早期诊断和恰当管理。此前，“疑似子痫前期孕妇短期结局预测研究（PROGNOSIS）”及“PROGNOSIS亚洲研究”表明，可溶性fms样酪氨酸激酶1（sFlt-1）/胎盘生长因子（PlGF）比值≤38可用于在1周内排除子痫前期，阴性预测值分别为99.3%和98.6%。这是对PROGNOSIS亚洲研究中国队列（n = 225）的一项探索性亚组分析。主要目的是评估使用sFlt-1/PlGF比值在1周内排除子痫前期以及在4周内确诊子痫前期的预测性能。还对子痫前期的sFlt-1/PlGF比值进行了胎儿不良结局、孕产妇不良结局及分娩时间的短期预测研究。子痫前期的总体患病率为17.3%。使用sFlt-1/PlGF比值≤38时，1周内排除子痫前期的阴性预测值为97.3%[95%置信区间（CI），93.8 - 99.1]，敏感性为64.3%，特异性为85.3%。使用sFlt-1/PlGF比值>38时，4周内确诊子痫前期的阳性预测值为35.0%（95%CI，20.6 - 51.7），敏感性为50.0%，特异性为86.8%。在sFlt-1/PlGF比值与胎儿不良结局的分析中，1周内排除胎儿不良结局的受试者工作特征曲线下面积为92.8%（95%CI，83.5 - 98.7），4周内确诊胎儿不良结局的受试者工作特征曲线下面积为79.9%（95%CI，68.1 - 90.3）。与比值≤38相比，sFlt-1/PlGF比值>38使即将分娩的可能性增加了3.3倍[风险比，3.3（95%CI，2.1 - 5.1）]。该亚组分析证实，sFlt-1/PlGF比值临界值38对于中国女性子痫前期的短期预测具有较高的预测性能，这可能有助于避免子痫前期低风险女性不必要的住院治疗。
