左侧先天性心脏病中的脐血心血管生物标志物
Cord Blood Cardiovascular Biomarkers in Left-Sided Congenital Heart Disease.
作者信息
Soveral Iris, Guirado Laura, Escobar-Diaz Maria C, Alcaide María José, Martínez Josep Maria, Rodríguez-Sureda Víctor, Bijnens Bart, Antolin Eugenia, Llurba Elisa, Bartha Jose L, Gómez Olga, Crispi Fàtima
机构信息
BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), 08028 Barcelona, Spain.
Obstetrics Department, Hospital General de Hospitalet, 08906 Barcelona, Spain.
出版信息
J Clin Med. 2022 Nov 30;11(23):7119. doi: 10.3390/jcm11237119.
Fetal echocardiography has limited prognostic ability in the evaluation of left-sided congenital heart defects (left heart defects). Cord blood cardiovascular biomarkers could improve the prognostic evaluation of left heart defects. A multicenter prospective cohort (2013−2019) including fetuses with left heart defects (aortic coarctation, aortic stenosis, hypoplastic left heart, and multilevel obstruction (complex left heart defects) subdivided according to their outcome (favorable vs. poor), and control fetuses were evaluated in the third trimester of pregnancy at three referral centers in Spain. Poor outcome was defined as univentricular palliation, heart transplant, or death. Cord blood concentrations of N-terminal precursor of B-type natriuretic peptide, Troponin I, transforming growth factor β, placental growth factor, and soluble fms-like tyrosine kinase-1 were determined. A total of 45 fetuses with left heart defects (29 favorable and 16 poor outcomes) and 35 normal fetuses were included, with a median follow-up of 3.1 years (interquartile range 1.4−3.9). Left heart defects with favorable outcome showed markedly increased cord blood transforming growth factor β (normal heart median 15.5 ng/mL (6.8−21.4) vs. favorable outcome 51.7 ng/mL (13.8−73.9) vs. poor outcome 25.1 ng/mL (6.9−39.0), p = 0.001) and decreased placental growth factor concentrations (normal heart 17.9 pg/mL (13.8−23.9) vs. favorable outcome 12.8 pg/mL (11.7−13.6) vs. poor outcome 11.0 pg/mL (8.8−15.4), p < 0.001). Poor outcome left heart defects had higher N-terminal precursor of B-type natriuretic peptide (normal heart 508.0 pg/mL (287.5−776.3) vs. favorable outcome 617.0 pg/mL (389.8−1087.8) vs. poor outcome 1450.0 pg/mL (919.0−1645.0), p = 0.001) and drastically reduced soluble fms-like tyrosine kinase-1 concentrations (normal heart 1929.7 pg/mL (1364.3−2715.8) vs. favorable outcome (1848.3 pg/mL (646.9−2313.6) vs. poor outcome 259.0 pg/mL (182.0−606.0), p < 0.001). Results showed that fetuses with left heart defects present a distinct cord blood biomarker profile according to their outcome.
胎儿超声心动图在评估左侧先天性心脏缺陷（左心缺陷）方面的预后能力有限。脐血心血管生物标志物可改善左心缺陷的预后评估。一项多中心前瞻性队列研究（2013 - 2019年）纳入了患有左心缺陷的胎儿（主动脉缩窄、主动脉狭窄、左心发育不全和多级梗阻（复杂左心缺陷），并根据其结局（良好与不良）进行细分），同时纳入了对照胎儿，于妊娠晚期在西班牙的三个转诊中心进行评估。不良结局定义为单心室姑息治疗、心脏移植或死亡。测定了脐血中B型利钠肽前体N端、肌钙蛋白I、转化生长因子β、胎盘生长因子和可溶性fms样酪氨酸激酶-1的浓度。共纳入45例患有左心缺陷的胎儿（29例结局良好，16例结局不良）和35例正常胎儿，中位随访时间为3.1年（四分位间距1.4 - 3.9年）。结局良好的左心缺陷胎儿脐血转化生长因子β明显升高（正常心脏中位值15.5 ng/mL（6.8 - 21.4），结局良好为51.7 ng/mL（13.8 - 73.9），结局不良为25.1 ng/mL（6.9 - 39.0），p = 0.001），胎盘生长因子浓度降低（正常心脏17.9 pg/mL（13.8 - 23.9），结局良好为12.8 pg/mL（11.7 - 13.6），结局不良为11.0 pg/mL（8.8 - 15.4），p < 0.001）。结局不良的左心缺陷胎儿B型利钠肽前体N端更高（正常心脏508.0 pg/mL（287.5 - 776.3），结局良好为617.0 pg/mL（389.8 - 1087.8），结局不良为1450.0 pg/mL（919.0 - 1645.0）），可溶性fms样酪氨酸激酶-1浓度大幅降低（正常心脏1929.7 pg/mL（1364.3 - 2715.8），结局良好为1848.3 pg/mL（646.9 - 2313.6），结局不良为259.0 pg/mL（182.0 - 606.0），p < 0.001）。结果表明，患有左心缺陷的胎儿根据其结局呈现出独特的脐血生物标志物谱。
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