University Hospital Leipzig, Leipzig, Germany.
Hospital Universitario 12 de Octubre, Madrid, Spain.
Ultrasound Obstet Gynecol. 2023 Feb;61(2):168-180. doi: 10.1002/uog.26032.
Pre-eclampsia (PE) is characterized by placental and maternal endothelial dysfunction, and associated with fetal growth restriction (FGR), placental abruption, preterm delivery and stillbirth. The angiogenic factors soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are altered in pregnancies complicated by placenta-related disorders. In this Review, we summarize the existing knowledge, examining the performance of maternal PlGF, sFlt-1 and the sFlt-1/PlGF ratio for screening PE, predicting development of PE in the short term, diagnosing PE, monitoring established PE and predicting other placenta-related disorders in singleton pregnancy. We also discuss the performance of PlGF and the sFlt-1/PlGF ratio for predicting PE in twin pregnancy. For first-trimester screening in singleton pregnancy, a more accurate way of identifying high-risk women than current practice is to combine maternal PlGF levels with clinical risk factors and ultrasound markers. Later in pregnancy, the sFlt-1/PlGF ratio has advantages over PlGF because it has a higher pooled sensitivity and specificity for diagnosing and monitoring PE. It has clinical value because it can rule out the development of PE in the 1-4-week period after the test. Once a diagnosis of PE is established, repeat measurement of sFlt-1 and PlGF can help monitor progression of the condition and may inform clinical decision-making regarding the optimal time for delivery. The sFlt-1/PlGF ratio is useful for predicting FGR and preterm delivery, but the association between stillbirth and the angiogenic factors is unclear. The sFlt-1/PlGF ratio can be used to predict PE in twin pregnancy, although different sFlt-1/PlGF ratio cut-offs from those for singleton pregnancy should be applied for optimal performance. In summary, PlGF, sFlt-1 and the sFlt-1/PlGF ratio are useful for screening, diagnosing, predicting and monitoring placenta-related disorders in singleton and twin pregnancy. We propose that tests for these angiogenic factors are integrated more fully into clinical practice.© 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
子痫前期 (PE) 的特征是胎盘和母体血管内皮功能障碍，与胎儿生长受限 (FGR)、胎盘早剥、早产和死胎有关。在与胎盘相关疾病相关的妊娠中，血管生成因子可溶性 fms 样酪氨酸激酶-1 (sFlt-1) 和胎盘生长因子 (PlGF) 发生改变。在本综述中，我们总结了现有的知识，检查了母体 PlGF、sFlt-1 和 sFlt-1/PlGF 比值在 PE 筛查、短期预测 PE 发展、PE 诊断、监测已建立的 PE 和预测单胎妊娠中其他与胎盘相关的疾病方面的表现。我们还讨论了 PlGF 和 sFlt-1/PlGF 比值在预测双胎妊娠中 PE 的表现。对于单胎妊娠的早孕期筛查，比目前的实践更准确的识别高危妇女的方法是将母体 PlGF 水平与临床危险因素和超声标志物相结合。在妊娠后期，sFlt-1/PlGF 比值优于 PlGF，因为它具有更高的汇总敏感性和特异性，可用于诊断和监测 PE。它具有临床价值，因为它可以排除测试后 1-4 周内 PE 的发展。一旦确诊为 PE，重复测量 sFlt-1 和 PlGF 有助于监测病情进展，并可能为最佳分娩时机的临床决策提供信息。sFlt-1/PlGF 比值可用于预测 FGR 和早产，但与血管生成因子相关的死产的相关性尚不清楚。sFlt-1/PlGF 比值可用于预测双胎妊娠中的 PE，尽管应应用与单胎妊娠不同的 sFlt-1/PlGF 比值切点以获得最佳性能。总之，PlGF、sFlt-1 和 sFlt-1/PlGF 比值可用于筛查、诊断、预测和监测单胎和双胎妊娠中的胎盘相关疾病。我们建议更全面地将这些血管生成因子的检测纳入临床实践。
