Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Institute of Health Research, University of Exeter, Exeter, UK.
Ultrasound Obstet Gynecol. 2022 Jun;59(6):731-736. doi: 10.1002/uog.24914.
To examine the potential value of maternal ophthalmic artery Doppler at 11-13 weeks' gestation, alone and in combination with the established first-trimester biomarkers of pre-eclampsia (PE), including uterine artery pulsatility index (UtA-PI), mean arterial pressure (MAP), serum placental growth factor (PlGF) and serum pregnancy-associated plasma protein-A (PAPP-A), in the prediction of subsequent development of PE.
This was a prospective observational study in women attending for a routine hospital visit at 11 + 0 to 13 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination for fetal anatomy and growth, assessment of flow velocity waveforms from the maternal ophthalmic arteries and calculation of the second-to-first peak systolic velocity (PSV) ratio, and measurement of MAP and serum PAPP-A. In addition, a case-control study was carried out for measurement of PlGF in stored samples from cases that developed PE and unaffected controls. The values of PSV ratio, UtA-PI, MAP, PAPP-A and PlGF were converted to multiples of the median or deltas to remove the effects of maternal characteristics and medical history. The competing-risks model was used to estimate the individual patient-specific risk of delivery with PE at < 37 and < 41 + 3 weeks' gestation for various combinations of markers. Performance was assessed using detection rates, at a fixed false-positive rate (FPR), and areas under the receiver-operating-characteristics curves. Modeled performance was also assessed.
The study population of 4066 pregnancies contained 114 (2.8%) that developed PE, including 25 (0.6%) that delivered with PE at < 37 weeks' gestation. The PSV ratio was significantly increased in PE pregnancies, and the effect of PE depended on gestational age at delivery, with the deviation from normal being greater for early than for late PE. Modeling demonstrated that the addition of PSV ratio improved the detection rate, at a 10% FPR, of preterm PE provided by maternal risk factors alone (from 46.3% to 58.4%), maternal factors, MAP and UtA-PI (65.9% to 70.6%), and maternal factors, MAP, UtA-PI and PlGF (74.6% to 76.7%). The PSV ratio did not improve the prediction of term PE provided by any combination of biomarkers.
Ophthalmic artery PSV ratio at 11-13 weeks' gestation is a potentially useful biomarker for prediction of subsequent development of preterm PE, but larger studies are needed to validate this finding. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
探讨 11-13 孕周时母体眼动脉多普勒的潜在价值，以及其与子痫前期（PE）的既定早期标志物（包括子宫动脉搏动指数（UtA-PI）、平均动脉压（MAP）、血清胎盘生长因子（PlGF）和血清妊娠相关血浆蛋白-A（PAPP-A））联合应用，对预测随后发生的 PE 的价值。
这是一项在 11+0 至 13+6 孕周时进行常规医院就诊的女性中进行的前瞻性观察性研究。该就诊包括记录母体人口统计学特征和病史、胎儿解剖结构和生长的超声检查、对母体眼动脉的流速波形进行评估和计算第二峰到第一峰收缩期速度（PSV）比值，以及测量 MAP 和血清 PAPP-A。此外，还对发生 PE 和未受影响的对照组的储存样本进行了 PlGF 的病例对照研究。PSV 比值、UtA-PI、MAP、PAPP-A 和 PlGF 的值被转换为中位数的倍数或差值，以消除母体特征和病史的影响。使用竞争风险模型估计各种标志物组合下，各患者在<37 周和<41+3 周时发生 PE 的分娩风险。使用检测率（在固定的假阳性率（FPR）下）和受试者工作特征曲线下面积来评估性能。还评估了模型性能。
4066 例妊娠的研究人群中，有 114 例（2.8%）发生了 PE，其中 25 例（0.6%）在<37 周时发生了 PE。PE 妊娠的 PSV 比值显著升高，PE 的影响取决于分娩时的孕周，早期 PE 的偏离程度大于晚期 PE。建模表明，在 10%的 FPR 下，PSV 比值可提高母体危险因素单独预测早产 PE 的检测率（从 46.3%提高到 58.4%）、母体因素、MAP 和 UtA-PI（从 65.9%提高到 70.6%）和母体因素、MAP、UtA-PI 和 PlGF（从 74.6%提高到 76.7%）。PSV 比值不能提高任何生物标志物组合预测足月 PE 的能力。
11-13 孕周时眼动脉 PSV 比值是预测随后发生早产 PE 的潜在有用的生物标志物，但需要更大的研究来验证这一发现。
