Christchurch Women's Hospital, Canterbury District Health Board, Christchurch, New Zealand.
Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand.
Aust N Z J Obstet Gynaecol. 2023 Feb;63(1):34-41. doi: 10.1111/ajo.13549. Epub 2022 Jun 7.
Internationally, placental growth factor (PlGF)-based tests are used as prognostic markers in suspected preeclampsia. However, Ministry of Health guidelines do not currently endorse PlGF-based tests in New Zealand (NZ).
To investigate the predictive value of soluble fms-like tyrosine kinase 1 (sFlt-1)/PlGF ratio in suspected preeclampsia in a NZ population.
A prospective cohort study of singleton pregnancies at 20 -36 weeks gestation with suspected preeclampsia as defined by Society of Obstetric Medicine Australia and NZ (SOMANZ) criteria.
to evaluate a sFlt-1/PlGF ratio >38 at ≤35 weeks gestation to predict birth ≤14 days.
to assess a sFlt-1/PlGF ratio cut-off of 38 at ≤37 weeks gestation, to rule out preeclampsia ≤1 week, rule in preeclampsia ≤4 weeks, and to predict perinatal outcome. Clinicians were blinded to sFlt-1/PlGF ratio results.
Included were 222 participants, 19.4% Māori and 10.4% Pasifika. A sFlt-1/PlGF >38 predicted birth ≤14 days, positive predictive value (PPV) 51.4% (95% CI, 39.6-63.0) and negative predictive value (NPV) 95.9% (95% CI, 91.4-98.1), median (interquartile range) days to birth 14 (2-27) vs 49 (33-70), P < 0.000. A sFlt-1/PlGF cut-off of 38 ruled out preeclampsia ≤1 week (NPV 96.2% (95% CI, 92.3-98.2)) and ruled in preeclampsia ≤4 weeks (PPV 75.0% (95% CI, 65.0-82.9)). A sFlt-1/PlGF >38 was associated with greater perinatal morbidity.
The predictive value of the sFlt-1/PlGF ratio in NZ is comparable to that reported in international trials. Used in clinical practice the sFlt-1/PlGF ratio may aid risk stratification in suspected preeclampsia, directing limited resources to those pregnancies at highest risk.
在国际上，胎盘生长因子（PlGF）检测被用作疑似子痫前期的预后标志物。然而，新西兰卫生部的指南目前并不认可 PlGF 检测。
探讨新西兰人群中可溶性 fms 样酪氨酸激酶 1（sFlt-1）/胎盘生长因子（PlGF）比值在疑似子痫前期中的预测价值。
对 20-36 孕周疑似子痫前期的单胎妊娠进行前瞻性队列研究，采用澳大利亚和新西兰妇产科医生协会（SOMANZ）标准定义疑似子痫前期。
评估≤35 孕周时 sFlt-1/PlGF 比值>38 预测出生≤14 天。
评估≤37 孕周时 sFlt-1/PlGF 比值 38 预测≤1 周内子痫前期，≤4 周内子痫前期，以及预测围产期结局。临床医生对 sFlt-1/PlGF 比值的结果不知情。
共纳入 222 例患者，19.4%为毛利人，10.4%为太平洋岛民。sFlt-1/PlGF>38 预测出生≤14 天，阳性预测值（PPV）为 51.4%（95%可信区间，39.6-63.0），阴性预测值（NPV）为 95.9%（95%可信区间，91.4-98.1），中位（四分位间距）出生天数为 14 天（2-27 天）与 49 天（33-70 天），P<0.000。sFlt-1/PlGF 比值 38 排除≤1 周的子痫前期（NPV 96.2%（95%可信区间，92.3-98.2%））和≤4 周的子痫前期（PPV 75.0%（95%可信区间，65.0-82.9%））。sFlt-1/PlGF>38 与围产期发病率增加有关。
新西兰 sFlt-1/PlGF 比值的预测价值与国际试验报告的结果相当。在临床实践中，sFlt-1/PlGF 比值可用于疑似子痫前期的风险分层，将有限的资源用于风险最高的妊娠。
