高危孕妇孕早期血清PLGF、sFlt-1与子痫前期发生及预测效能

Relationship between the serum PLGF and sFlt-1 levels of high-risk pregnant women during the first trimester of pregnancy and their preeclampsia occurrence and the predictive efficiency of the serum PLGF and sFlt-1 levels for preeclampsia

目的:分析高危孕妇孕早期血清胎盘生长因子(PLGF)和可溶性血管内皮生长因子受体-1(sFlt-1)水平预测子痫前期的临床价值。方法:回顾性收集2018年1月-2021年1月在本院规律产前检查且分娩的100例高危孕妇临床资料,确诊子痫前期42例纳入观察组,余58例纳入对照组。另根据病情程度将观察组分为轻度子痫前期22例和重度子痫前期20例。比较各组孕早期血清PLGF和sFlt-1水平差异,分析二者预测高危孕妇子痫前期价值。结果:观察组与对照组孕早期血清PLGF(38.69±9.62 pg/ml、58.17±14.33 pg/ml)和sFlt-1(1468.88±217.14 pg/ml、998.62±148.37 pg/ml)均有差异,且轻度子痫前期与重度子痫前期血清PLGF(44.13±10.16 pg/ml、25.89±7.12 pg/ml)和sFlt-1(1228.49±175.55 pg/ml、1802.60±246.10 pg/ml)有差异(P<0.05)。Pearson相关性分析显示,孕早期血清PLGF、sFlt-1水平与子痫前期病情程度分别呈负相关和正相关(r=-0.582、0.604,均P<0.05);PLGF在最佳截断值46.23 pg/ml时预测高危孕妇子痫前期的AUC为0.766,敏感度为78.9%,特异度为74.6%;sFlt-1在最佳截断值1145.50 pg/ml时预测高危孕妇子痫前期的AUC为0.783,敏感度为80.02%,特异度为76.11%。二者联合检测的AUC为0.946,敏感度为91.2%,特异度为92.7%。结论:血清PLGF降低、sFlt-1升高可能与孕早期高危孕妇子痫前期的发生和进展有关,检测血清PLGF和sFlt-1水平可作为预测参考指标。

Objective:To analyze the value of the levels of serum placental growth factor(PLGF)and soluble fms-like tyrosine kinase-1(sFlt-1)of high-risk pregnant women during the first trimester of pregnancy for predicting their preeclampsia occurrence.Methods:The clinical data of 100 high-risk pregnant women who received regular antenatal care and delivery from January 2018 to January 2021 were collected retrospectively.These women were included 42 women with preeclampsia in observation group,and 58 women without preeclampsia in control group.The women in the observation group were further divided in group A(22 women with mild preeclampsia)and group B(20 women with severe preeclampsia)according to the severity of preeclampsia.The differences of the serum PLGF and sFlt-1 levels of the women during the first trimester of pregnancy were compared among these groups.The values of the serum PLGF and sFlt-1 levels of the women for predicting their preeclampsia was analyzed.Results:There were significant differences in the serum PLGF level(38.69±9.62 pg/ml vs.58.17±14.33 pg/ml)and the serum SFLT-1 level(1468.88±217.14 pg/ml vs.998.62±148.37 pg/ml)of the women during the first trimester of pregnancy between the observation group and the control group.There were significant differences in the serum PLGF level(44.13±10.16 pg/ml vs.25.89±7.12 pg/ml)and the serum SFLT-1 level(1228.49±175.55 pg/ml vs.1802.60±246.10 pg/ml)of the women during the first trimester of pregnancy between group A and group B(P<0.05).Pearson correlation analysis showed that the serum PLGF level of the women during the first trimester of pregnancy was negatively correlated with the severity of preeclampsia(r=-0.582,P<0.05),and the serum SFLT-1 level of the women was positively correlated with the severity of preeclampsia(r=0.604,P<0.05).When the optimal cut-off value of the PLGF level was 46.23 pg/ml,the AUC,the sensitivity and the specificity of the PLGF level for predicting preeclampsia of the high-risk pregnant women were 0.766,78.9%,and 74.6%,respectively.When the optimal cut-off value of the sFlt-1 level was 1145.50 pg/ml,the AUC,the sensitivity,and the specificity of the sFlt-1 level for predicting preeclampsia of the high-risk pregnant women were 0.783,80.02%,and 76.11%,respectively.The AUC,the sensitivity and the specificity of the combined of the levels of PLGF and sFlt-1 for predicting preeclampsia were 0.946,91.2%,and 92.7%,respectively.Conclusion:The decrease of the serum PLGF level and the increase of the serum sFlt-1 level of the high-risk pregnant women may be related to their occurrence and progression of preeclampsia during the first trimester of pregnancy.Detections of serum PLGF and sFlt-1 levels of the high-risk pregnant women can be used as the reference indicators for predicting preeclampsia.