sFlt-1/PlGF比值联合D-二聚体评估子痫前期妊娠结局的临床价值

The clinical value of sFlt-1/PlGF ratio combined with D-D in assessing the pregnancy outcomes of preeclampsia

目的探讨可溶性fms样酪氨酸激酶1(sFlt-1)/胎盘生长因子(PlGF)比值联合D-二聚体(D-D)评估子痫前期(PE)妊娠结局的临床价值。方法回顾性选取2021年12月至2023年1月收治的102例PE患者作为子痫前期组,另选取同期在我院进行产前检查的正常孕妇60例作为对照组,比较两组28至32周时血清sFlt-1、PlGF、sFlt-1/PlGF比值、D-D水平,采用受试者工作特征(ROC)曲线分析sFlt-1/PlGF比值联合D-D对妊娠结局的预测价值。结果子痫组血清sFlt-1、sFlt-1/PlGF比值、D-D水平高于对照组,PlGF水平低于对照组(t值分别为10.855、20.310、17.002和15.365,P<0.05);Logistic分析显示,高体质量指数(BMI)、妊娠期糖尿病或肾病、既往子痫前期史、sFlt-1/PlGF比值、D-D均为影响孕妇发生子痫前期的独立危险因素,其OR值及95%CI分别为18.171(6.493~50.849)、4.259(1.096~16.547)、11.367(1.226~105.391)、7.939(2.514~25.068)和1.567(1.330~1.845),P<0.05。不良妊娠结局组血清sFlt-1、sFlt-1/PlGF比值、D-D水平高于非不良妊娠结局组,PlGF水平低于非不良妊娠结局组(t值分别为4.759、5.646、5.331和3.135,P<0.05)。ROC曲线显示,sFlt-1/PlGF比值联合D-D预测妊娠结局的曲线下面积(AUC)为0.843,灵敏度和特异度分别为79.41%和75.00%。结论子痫前期患者血清sFlt-1/PlGF比值、D-D水平升高,二者可用于评估子痫前期妊娠结局。

Objective To explore the clinical value of the soluble fms-like tyrosine kinase-1(sFlt-1)/placental growth factor(PlGF)ratio combined with D-dimer(D-D)in assessing the pregnancy outcomes of preeclampsia(PE).Methods Retrospectively,102 cases of PE patients admitted from December 2021 to January 2023 were selected as the PE group,while 60 normal pregnant women undergoing prenatal examinations in our hospital during the same period were selected as the control group.The serum sFlt-1,PlGF,sFlt-1/PlGF ratio and D-D at 28 to 32 weeks were compared between the two groups.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of sFlt-1/PlGF ratio combined with D-D for pregnancy outcome.Results Serum levels of sFlt-1,sFlt-1/PlGF ratio and D-D in PE group were higher than those in control group,while PlGF level in the PE group was lower than those in control group(t=10.855,20.310,17.002,and 15.365,P<0.05).Logistic analysis showed that high body mass index(BMI),gestational diabetes mellitus or kidney disease,history of PE,sFlt-1/PlGF ratio and D-D were independent risk factors for PE in pregnant women,with OR values and 95%CI of 18.171(6.493-50.849),4.259(1.096-16.547),11.367(1.226-105.391),7.939(2.514-25.068),and 1.567(1.330-1.845),respectively,P<0.05.Serum levels of sFlt-1,sFlt-1/PlGF ratio and D-D in adverse pregnancy outcome group were higher than those in good pregnancy outcome group,while PlGF level was lower than those in non-adverse pregnancy outcome group,while PlGF levels in adverse pregnancy outcome group were lower than in the non-adverse pregnancy outcome group(t=4.759,5.646,5.331,and 3.135,P<0.05).ROC curves analysis showed that sFlt-1/PlGF ratio combined with D-D had an area under the curve(AUC)of 0.843 for predicting pregnancy outcomes,with sensitivity and specificity of 79.41%and 75.00%,respectively.Conclusion PE patients have elevated serum sFlt-1/PlGF ratio and D-D levels,both of which can be used to assess the pregnancy outcome of PE.