Palmrich P, Kalafat E, Pateisky P, Schirwani-Hartl N, Haberl C, Herrmann C, Khalil A, Binder J
Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria.
Department of Obstetrics and Gynecology, School of Medicine, Koc University, Istanbul, Turkey.
Ultrasound Obstet Gynecol. 2024 May;63(5):619-626. doi: 10.1002/uog.27509.
Pregnancies with fetal growth restriction (FGR) are at increased risk for pre-eclampsia. Angiogenic markers including soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are altered in pregnancies complicated by FGR, but their utility for predicting pre-eclampsia in growth-restricted pregnancies is uncertain. This study aimed to evaluate the prognostic value of angiogenic markers for predicting the development of pre-eclampsia in pregnancies with FGR and suspected pre-eclampsia.
This was a retrospective study of singleton pregnancies with FGR, defined according to Delphi consensus criteria, which underwent sampling of sFlt-1 and PlGF for suspicion of pre-eclampsia at the Medical University of Vienna, Vienna, Austria, between 2013 and 2020. Women with an established diagnosis of pre-eclampsia at sampling were excluded. Cox regression analysis and logistic regression analysis were performed to evaluate the association of angiogenic markers with the development of pre-eclampsia at various timepoints.
In this cohort of 93 women, pre-eclampsia was diagnosed in 14 (15.1%) women within 1 week after sampling, 21 (22.6%) within 2 weeks after sampling and 38 (40.9%) at any time after assessment. The sFlt-1/PlGF ratio consistently showed a stronger association with the development of pre-eclampsia compared to sFlt-1 or PlGF alone (pre-eclampsia within 1 week: area under the receiver-operating-characteristics curve, 0.87 vs 0.82 vs 0.72). Models including the sFlt-1/PlGF ratio were associated more strongly with pre-eclampsia hazard compared to models including sFlt-1 or PlGF alone (concordance index, 0.790 vs 0.759 vs 0.755). The risk classification capability of the sFlt-1/PlGF ratio decreased after the 2-week timepoint. The established cut-off value for the sFlt-1/PlGF ratio of < 38 was effective for ruling out pre-eclampsia within 2 weeks, with a negative predictive value of 0.933 and sensitivity of 0.952.
Use of the sFlt-1/PlGF ratio is preferrable to the use of PlGF alone for the prediction of pre-eclampsia in pregnancies with FGR. Established cut-offs for ruling out the development of pre-eclampsia in the short term seem to be effective in these patients. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
胎儿生长受限（FGR）的妊娠发生子痫前期的风险增加。包括可溶性fms样酪氨酸激酶-1（sFlt-1）和胎盘生长因子（PlGF）在内的血管生成标志物在合并FGR的妊娠中会发生改变，但其在预测生长受限妊娠中的子痫前期方面的效用尚不确定。本研究旨在评估血管生成标志物对预测FGR和疑似子痫前期妊娠中子痫前期发生的预后价值。
这是一项对单胎FGR妊娠的回顾性研究，FGR根据德尔菲共识标准定义，于2013年至2020年期间在奥地利维也纳医科大学因疑似子痫前期接受了sFlt-1和PlGF采样。在采样时已确诊子痫前期的女性被排除。进行Cox回归分析和逻辑回归分析，以评估血管生成标志物与不同时间点子痫前期发生之间的关联。
在这个由93名女性组成的队列中，14名（15.1%）女性在采样后1周内被诊断为子痫前期，21名（22.6%）在采样后2周内被诊断为子痫前期，38名（40.9%）在评估后的任何时间被诊断为子痫前期。与单独使用sFlt-1或PlGF相比，sFlt-1/PlGF比值始终显示出与子痫前期发生的更强关联（采样后1周内子痫前期：受试者工作特征曲线下面积，分别为0.87、0.82和0.72）。与仅包含sFlt-1或PlGF的模型相比，包含sFlt-1/PlGF比值的模型与子痫前期风险的关联更强（一致性指数，分别为0.790、0.759和0.755）。sFlt-1/PlGF比值的风险分类能力在2周时间点后下降。sFlt-1/PlGF比值<38的既定临界值在2周内排除子痫前期有效，阴性预测值为0.933，敏感性为0.952。
在预测FGR妊娠中的子痫前期时，使用sFlt-1/PlGF比值比单独使用PlGF更可取。在短期内排除子痫前期发生的既定临界值在这些患者中似乎是有效的。©2023作者。《妇产科超声》由约翰·威利父子有限公司代表国际妇产科超声学会出版。
