Gómez Fernández Cristina, Otero Naveiro Ana, Raña Mayán Andrea, Álvarez Fernández Rebeca, Pérez Fernández Rebeca, Paz Fernández Eugenio
Department of Ginecology and Obstetrics, Lucus Augusti University Hospital, Lugo, Spain -
Department of Ginecology and Obstetrics, Lucus Augusti University Hospital, Lugo, Spain.
Minerva Obstet Gynecol. 2023 Oct;75(5):412-423. doi: 10.23736/S2724-606X.22.05083-7. Epub 2022 Jun 22.
Preeclampsia (PE) is a hypertensive disorder of pregnancy and one of the leading causes of maternal and fetal morbidity and mortality worldwide. While the underlying cause of remains unknown, abnormal placentation in early stages of pregnancy is thought to be a main triggering event for the more severe and early-onset forms. A consequence of placental insufficiency is an imbalance of angiogenic factors in the maternal circulation. The objective was to assess the utility of the angiogenic biomarker sFlt-1/PlGF for the diagnosis, follow-up and prognosis of preeclampsia.
This was a retrospective cohort study based including 65 consecutive singleton pregnancies with suspected preeclampsia referred to our hospital between January 2018 and February 2019. PE was defined as early-onset (20-33+6 weeks) and late-onset (≥34 weeks). The main independent variable was sFlt-1/PlGF classified in women with early or late onset PE, respectively, as low when <38 or <38, intermediate when 38-84 or 38-109, and high when ≥85 or ≥110.
PE was confirmed in 14 (4 early-onset, 10 late-onset) of the participants. 122 sFlt-1/PIGF ratio determinations were requested. The optimal sFlt-1/PlGF to predict PE was ≥86 with a sensitivity of 93% and a specificity of 96% (AUC 0.95; CI 95% 0.90-1.0; P<0.001). A multilevel logistic model for the diagnosis of PE was adjusted for age, Body Mass Index, diabetes, proteinuria and mean arterial pressure. Women were 16.5 times (P=0.013) more likely to develop PE if they had intermediate sFlt-1/PlGF levels and 451 times (P<0.001) more likely if they had high biomarker levels compared to those with levels below 38. The probability of PE was 3.73 times (P=0.046) greater in those with maternal and/or fetal complications.
The biomarker proved useful to diagnose PE and assess its prognosis. Patients diagnosed with PE had a higher frequency of complications and their newborns were of lower birth weight.
子痫前期（PE）是一种妊娠期高血压疾病，是全球孕产妇和胎儿发病及死亡的主要原因之一。虽然其根本原因尚不清楚，但妊娠早期胎盘形成异常被认为是更严重和早发型子痫前期的主要触发事件。胎盘功能不全的一个后果是母体循环中血管生成因子失衡。目的是评估血管生成生物标志物sFlt-1/PlGF对子痫前期诊断、随访及预后的作用。
这是一项回顾性队列研究，纳入了2018年1月至2019年2月期间转诊至我院的65例连续单胎妊娠且疑似子痫前期的孕妇。子痫前期分为早发型（20 - 33⁺⁶周）和晚发型（≥34周）。主要自变量是sFlt-1/PlGF，分别将早发型或晚发型子痫前期女性的sFlt-1/PlGF分为低水平（<38或<38）、中等水平（38 - 84或38 - 109）和高水平（≥⸺85或≥110）。
14例（4例早发型，10例晚发型）参与者确诊为子痫前期。共进行了122次sFlt-1/PIGF比值测定。预测子痫前期的最佳sFlt-1/PlGF为≥86，敏感性为93%，特异性为96%（AUC 0.95；95%CI 0.90 - 1.0；P<0.001）。针对子痫前期诊断的多水平逻辑模型对年龄、体重指数、糖尿病、蛋白尿和平均动脉压进行了校正。与sFlt-1/PlGF水平低于38的女性相比，sFlt-1/PlGF水平中等的女性发生子痫前期的可能性高16.5倍（P = 0.013），生物标志物水平高的女性发生子痫前期的可能性高451倍（P<0.001）。有母体和/或胎儿并发症的女性发生子痫前期的概率高3.73倍（P = 0.046）。
该生物标志物被证明有助于诊断子痫前期并评估其预后。诊断为子痫前期的患者并发症发生率更高，其新生儿出生体重更低。
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