这种方法竟然可以预测妇女先兆子痫?

孕期妇女在先兆子痫临床发病前可检测到可溶性fms样酪氨酸激酶1(sFlt-1)和胎盘生长因子(PLGF)比值升高,但这个比值对疑诊先兆子痫妇女的预测作用尚不明确。


欧洲的研究者开展了一项前瞻性、多中心的观察性研究,探讨疑诊先兆子痫的单胎妊娠妇女(妊娠24周0天至36周6天)的sFlt-1 、PLGF血清比值,是否对短期内先兆子痫的发生具有预测作用;其研究结果发表在了近期的新英格兰医学杂志上。主要目的是评估较低的sFlt-1:PLGF(等于或低于推导临界值)能否预测首次随访后1周内先兆子痫的发生,以及较高的sFlt-1:PLGF(高于临界值)能否预测4周内不发生先兆子痫。


研究者首先在已发病的先兆子痫队列中(n=500),推导出一个具有重要预测价值的sFlt-1:PLGF临界值为38。在随后的验证试验中,研究者纳入另外550名妇女,推导出sFlt-1:PLGF≤38的阴性预测值为99.3%(95%可信区间[CI]为97.9-99.9),即sFlt-1:PLGF≤38的妇女随后一周真正不发生先兆子痫的比例是99.3%,敏感性为80%(95%CI,51.9-95.7),特异性为78.3%(95% CI,74.6-81.7)。而sFlt-1:PLGF>38对4周内诊断先兆子痫的阳性预测值为36.7%(95% CI,28.4-45.7),敏感性为66.2%(95%CI,54-77),特异性为83.1%(95%CI,79.4-86.3)。


该研究提示,当临床症状可疑先兆子痫的妇女检测出sFlt-1:PLGF≤38时,即可在短期内排除先兆子痫的诊断。



Predictive Value of the sFlt-1:PlGF Ratio in Womenwith Suspected Preeclampsia.

BACKGROUND:

The ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) is elevated in pregnant women before the clinical onset of preeclampsia, but its predictive value in women with suspected preeclampsia is unclear.


METHODS:

We performed a prospective, multicenter, observational study to derive and validate a ratio of serum sFlt-1 to PlGF that would be predictive of the absence or presence of preeclampsia in the short term in women with single tonpregnancies in whom preeclampsia was suspected (24 weeks 0 days to 36 weeks 6days of gestation). Primary objectives were to assess whether low sFlt-1:PlGF ratios (at or below a derived cut off) predict the absence of preeclampsia within 1 week after the first visit and whether high ratios (above the cut off) predict the presence of preeclampsia within 4 weeks.


RESULTS:

In the development cohort (500 women), we identified an sFlt-1:PlGF ratiocut off of 38 as having important predictive value. In a subsequent validation study among an additional 550 women, an sFlt-1:PlGF ratio of 38 or lower had a negative predictive value (i.e., no preeclampsia in the subsequent week) of 99.3% (95% confidence interval [CI], 97.9 to 99.9), with 80.0% sensitivity (95%CI, 51.9 to 95.7) and 78.3% specificity (95% CI, 74.6 to 81.7). The positive predictive value of an sFlt-1:PlGF ratio above 38 for a diagnosis of preeclampsia within 4 weeks was 36.7% (95% CI, 28.4 to 45.7), with 66.2% sensitivity (95% CI, 54.0 to 77.0) and 83.1% specificity (95% CI, 79.4 to86.3).


CONCLUSIONS:

An sFlt-1:PlGF ratio of 38 or lower can be used to predict the short-term absence of preeclampsia in women in whom the syndrome is suspected clinically.


大医编原创翻译:Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia.[J]. The New England  Journal of Medicine. 2016Jan 7;374(1):13-22.



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