高危孕妇中sFlt-1和PLGF预测子痫前期的意义

Significance of sFlt-1 and PLGF in prediction of preeclampsia among high-risk pregnant women

目的探讨孕晚期可溶性血管内皮生长因子受体-1(sFlt-1)和胎盘生长因子(PLGF)的血清浓度对高危孕妇子痫前期发病的预测价值。方法选取2015年11月-2016年1月在同济大学附属第一妇婴保健院产科建卡产检、住院分娩的子痫前期高危孕妇271例为研究对象。采用电化学发光法检测孕妇静脉血血清sFlt-1和PLGF浓度,收集结果、记录数值并计算sFlt-1/PLGF比值。最终有11例孕妇发展为子痫前期纳入子痫前期组,其中5例为轻度子痫前期,6例为重度子痫前期,其余260例孕妇作为对照组。将检测结果与子痫前期的发病进行相关性分析。结果子痫前期组孕妇与对照组比较,血清log(sFlt-1)浓度差异无统计学意义(3.38±0.29vs.3.22±0.19,P=0.091),血清log(PLGF)浓度比较差异有统计学意义(2.19±0.43vs.2.66±3.05,P=0.000),血清log(sFlt-1/PLGF)比值比较差异有统计学意义(1.19±0.63vs.0.56±0.37,P=0.008)。轻度子痫前期孕妇与重度子痫前期孕妇中血清log(sFlt-1)、log(PLGF)、log(sFlt-1/PLGF)值分别为(3.33±0.26vs.3.43±0.44,P=0.594)、(2.43±0.52vs.1.99±0.21,P=0.090)、(0.90±0.73vs.1.43±0.46,P=0.170),差异均无统计学意义。血清sFlt-1/PLGF比值高危孕妇子痫前期的ROC曲线下面积为0.824,8.39为最佳截断值(灵敏度为72.7%,特异度为86.5%)。结论高危孕妇孕晚期血清中PLGF浓度,以及血清sFlt-1/PLGF比值与子痫前期的发病具有相关性,检测血清中sFlt-1、PLGF浓度对子痫前期的发生具有预测价值,以8.39为sFlt-1/PLGF比值的截断值对孕晚期子痫前期的发生具有很好的预测价值。

Objective To explore the value of serum levels of soluble vascular endothelial growth factor receptor-1 ( sFlt-1) and placental growth factor ( PLGF) in prediction of preeclampsia among high-risk pregnant women.Methods From December 2015 to January 2016,271 high-risk preeclampsia pregnant women establishing medical records and giving birth to their babies in Department of Obstetrics in Shanghai First Maternity and Infant Hospital Affiliated to Tongji University were selected as study object.Electrochemiluminescence was used to detect the levels of serum sFlt-1 and PLGF in venous blood,the data was collected and recorded.The ratio of sFlt-1 /PLGF was calculated.Totally,11 pregnant women were enrolled into preeclampsia group,including 5 pregnant women with mild preeclampsia and 6 pregnant women with severe preeclampsia,the other 260 pregnant women were enrolled into control group.The correlation between detection results and onset of preeclampsia was analyzed.Results Serum log ( sFlt-1) levels in preeclampsia group and control group were ( 3.38±0.29) and ( 3.22±0.19) ,respectively,there was no statistically significant difference between the two groups ( P= 0.091) .Serum log ( PLGF) levels in preeclampsia group and control group were ( 2.19±0.43) and ( 2.66±3.05) ,respectively,there was statistically significant difference between the two groups ( P= 0.000) .Serum log ( sFlt-1 /PLGF) ratios in preeclampsia group and control group were ( 1.19 ±0.63) and ( 0.56±0.37) ,respectively,there was statistically significant difference between the two groups ( P = 0.008) .Serum log ( sFlt-1) ,log ( PLGF) ,and log ( sFlt-1 /PLGF) ratio in mild preeclampsia group were ( 3.33±0.26) ,( 2.43±0.52) ,and ( 0.90 ±0.73) ,respectively;serum log ( sFlt- 1) ,log ( PLGF) ,and log ( sFlt- 1 /PLGF) ratio in severe preeclampsia group were ( 3.43± 0.44) ,( 1.99± 0.21) ,and ( 1.43±0.46) ,respectively,there was no statistically significant difference ( P= 0.594,P= 0.090,P= 0.170) .The area under ROC curve of serum sFlt- 1 /PLGF ratio was 0.824,the optimal cutoff value was 8.39,sensitivity and specificity were 72.7% and 86.5%,respectively.Conclusion Serum PLGF level and sFlt-1 /PLGF ratio during the third trimester of pregnancy among high-risk pregnant women are correlated with onset of preeclampsia.Detections of serum sFlt-1 and PLGF levels have predictive value for onset of preeclampsia.sFlt-1 /PLGF ratio cutoff value of 8.39 can be used to predict onset of preeclampsia during the third trimester of pregnancy.