孕晚期sFlt-1、PlGF与凝血—纤溶指标在子痫前期诊断中的应用价值

The Evaluation of sFlt-1,PlGF and Coagulation-fibrinolysis Indices in the Diagnosis of Preeclampsia in the Third Trimester

目的:评价孕晚期可溶性fms样酪氨酸激酶-1(sFlt-1)、胎盘生长因子(PlGF)和凝血—纤溶指标在子痫前期诊断中的临床应用价值。方法:选取4组孕晚期受试者,分别为健康对照组58例、妊娠期高血压(GH)组41例、轻度子痫前期(M-PE)组48例和重度子痫前期(S-PE)组47例;检测各组间sFlt-1、PlGF和凝血—纤溶指标水平;分析sFlt-1、PlGF与凝血—纤溶指标之间的相关性;绘制各参数的受试者工作特征(ROC)曲线分析凝血—纤溶指标在子痫前期中的诊断性能。结果:相比于对照组,M-PE组和S-PE组中sFlt-1水平明显增高(P<0.01),PlGF水平明显下降(P<0.01),sFlt-1随子痫前期严重程度逐渐升高;S-PE组相比于对照组活化部分凝血活酶时间(APTT)和凝血酶时间(TT)明显延长,纤维蛋白原(FIB)和抗凝血酶Ⅲ(ATⅢ)水平明显下降(P<0.05);ATⅢ与sFlt-1水平呈负相关(r=-0.592,P<0.0001),与PlGF水平呈正相关(r=0.304,P<0.0001);ROC曲线显示ATⅢ在M-PE和S-PE的曲线下面积(AUC)分别为0.681、0.807。结论:孕晚期子痫前期患者血清中的高水平sFlt-1与患者体内的凝血—纤溶障碍具有一定相关性;ATⅢ可作为孕晚期子痫前期发作和严重程度的监测标志物。

Objective:To evaluate the clinical application value of soluble fms-like tyrosine kinase-1(sFlt-1),placental growth factor(PlGF)and coagulation-fibrinolysis indices in the diagnosis of preeclampsia in the third trimester.Methods:Patients in the third trimester were divided into 4 groups based on clinical diagnosis:healthy control group(n=58),gestational hypertension group(GH)(n=41),mild preeclampsia group(M-PE)(n=48)and severe preeclampsia group(S-PE)(n=47);sFlt-1,PlGF and coagulation-fibrinolysis indices were measured and compared among the groups;Pearson correlation analysis was used to analyze the correlation between sFlt-1,PlGF and coagulation-fibrinolysis indices;the receiver-operating characteristic(ROC)curves were generated to analyze the diagnosis efficacy of coagulation-fibrinolysis indices in preeclampsia.Results:Compared with the control group,the sFlt-1 level was increased(P<0.01)while the PlGF level was decreased(P<0.01)in the M-PE group and S-PE group,and sFlt-1 gradually increased with the severity of preeclampsia;the activated partial thromboplastin time(APTT)and thrombin time(TT)levels were significantly increased while fibrinogen(FIB)and antithrombin Ⅲ(ATⅢ)levels were decreased in the S-PE group compared to control group(P<0.05);ATⅢ level was negatively correlated with sFlt-1 levels(r=-0.592,P<0.0001),but positively correlated with PlGF level(r=0.304,P<0.0001);ROC curve showed that the area under the curve(AUC)of ATⅢ in the M-PE group and S-PE group were 0.681 and 0.807,respectively.Conclusion:The high level of sFlt-1 in the serum of patients with preeclampsia in late pregnancy has a certain correlation with the dysfunction of the blood coagulation-fibrinolysis system;ATⅢ may serve as a monitoring marker for the onset and severity of preeclampsia in the third trimester.