血清可溶性血管内皮生长因子受体-1/胎盘生长因子比值联合子宫动脉血流超声在预测早发型子痫前期中的应用
Application of Serum sFlt-1/PlGF Ratio Combined with Uterine Artery Blood Flow Ultrasound in Predicting Early-Onset Preeclampsia.
作者信息
Zhang Han, Xu Cui
机构信息
Gynecology Department, the Second Affiliated Hospital of Shandong First Medical University, Tai 'an, Shandong, 271000, People's Republic of China.
Obstetrics Department, the Second Affiliated Hospital of Shandong First Medical University, Tai 'an, Shandong, 271000, People's Republic of China.
出版信息
Int J Womens Health. 2025 Aug 15;17:2561-2567. doi: 10.2147/IJWH.S539946. eCollection 2025.
OBJECTIVE
This study aimed to evaluate the predictive efficacy of combining serum soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio with uterine artery Doppler ultrasound for early-onset preeclampsia (PE) before 34 weeks' gestation.
METHODS
A retrospective cohort analysis was conducted on 148 singleton pregnancies (control group: n = 76; early-onset PE group: n = 72) who delivered at our institution between July 2023 and June 2024. At 24-28 weeks, serum sFlt-1 and PlGF levels were quantified via electrochemiluminescence immunoassay (Roche Elecsys), and uterine artery pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio (S/D) were measured by Doppler ultrasound (M22 system, standardized settings). Logistic regression and receiver operating characteristic (ROC) curves assessed predictive performance.
RESULTS
Compared to controls, PE patients exhibited significantly elevated sFlt-1 (24.02 ± 6.68 vs 16.38 ± 7.47 μg/L; P < 0.001), reduced PlGF (1.22 ± 0.14 vs 1.54 ± 0.30 μg/L; P < 0.001), and higher sFlt-1/PlGF ratio (20.76 ± 7.71 vs 10.11 ± 4.10; P < 0.001). Doppler indices were markedly increased in PE: PI (1.34 ± 0.26 vs 0.82 ± 0.11; P < 0.001), RI (0.78 ± 0.12 vs 0.51 ± 0.07; P < 0.001), and S/D (3.89 ± 0.97 vs 2.11 ± 0.41; P < 0.001). Multivariate analysis confirmed all parameters as independent predictors (P < 0.05), with sFlt-1/PlGF ratio having the highest odds ratio (OR = 1.332, 95% CI: 1.128-1.573). The combined model achieved superior predictive performance: area under curve (AUC)=0.954 (95% CI: 0.92-0.99) vs sFlt-1/PlGF alone (AUC = 0.887; P = 0.003) or PI alone (AUC = 0.821; P < 0.001), with sensitivity 82.2%, specificity 96.7%, and accuracy 94.7%.
CONCLUSION
Integration of sFlt-1/PlGF ratio and uterine artery Doppler parameters (particularly uterine artery PI and RI) significantly enhances early-onset PE prediction, providing a robust tool for clinical risk stratification.
目的
本研究旨在评估血清可溶性fms样酪氨酸激酶-1/胎盘生长因子（sFlt-1/PlGF）比值联合子宫动脉多普勒超声对妊娠34周前早发型子痫前期（PE）的预测效能。
方法
对2023年7月至2024年6月在我院分娩的148例单胎妊娠进行回顾性队列分析（对照组：n = 76；早发型PE组：n = 72）。在孕24 - 28周时，通过电化学发光免疫分析（罗氏Elecsys）定量检测血清sFlt-1和PlGF水平，并用多普勒超声（M22系统，标准化设置）测量子宫动脉搏动指数（PI）、阻力指数（RI）和收缩期/舒张期比值（S/D）。采用逻辑回归和受试者工作特征（ROC）曲线评估预测性能。
结果
与对照组相比，PE患者的sFlt-1显著升高（24.02±6.68 vs 16.38±7.47μg/L；P < 0.001），PlGF降低（1.22±0.14 vs 1.54±0.30μg/L；P < 0.001），sFlt-1/PlGF比值更高（20.76±7.71 vs 10.11±4.10；P < 0.001）。PE患者的多普勒指标明显升高：PI（1.34±0.26 vs 0.82±0.11；P < 0.001）、RI（0.78±0.12 vs 0.51±0.07；P < 0.001）和S/D（3.89±0.97 vs 2.11±0.41；P < 0.001）。多因素分析证实所有参数均为独立预测因子（P < 0.05），其中sFlt-1/PlGF比值的比值比最高（OR = 1.332，95%CI：1.128 - 1.573）。联合模型具有更好的预测性能：曲线下面积（AUC）=0.954（95%CI：0.92 - ），而单独的sFlt-1/PlGF（AUC = 0.887；P = 0.003）或单独的PI（AUC = 0.821；P < 0.001）的AUC分别为0.887和0.821，联合模型的敏感性为82.2%，特异性为96.7%，准确性为94.7%。
结论
sFlt-1/PlGF比值与子宫动脉多普勒参数（特别是子宫动脉PI和RI）相结合可显著提高早发型PE的预测能力，为临床风险分层提供有力工具。
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