Plasma concentrations of angiogenic/anti-angiogenic factors have prognostic value in women presenting with suspected preeclampsia to the obstetrical triage area: a prospective study

被引:67
作者
Chaiworapongsa, Tinnakorn [1 ,2 ]
Romero, Roberto [1 ]
Korzeniewski, Steven J. [1 ,2 ]
Cortez, Josef M. [3 ]
Pappas, Athina [3 ]
Tarca, Adi L. [1 ,4 ]
Chaemsaithong, Piya [1 ,2 ]
Dong, Zhong [1 ]
Yeo, Lami [1 ,2 ]
Hassan, Sonia S. [1 ,2 ]
机构
[1] NICHD, Perinatol Res Branch, NIH, DHHS, Detroit, MI USA
[2] Wayne State Univ, Dept Obstet Gynecol, Detroit, MI 48201 USA
[3] Wayne State Univ, Dept Pediat, Detroit, MI 48201 USA
[4] Wayne State Univ, Dept Comp Sci, Detroit, MI 48201 USA
基金
美国国家卫生研究院;
关键词
Maternal outcome; neonatal outcome; placental growth factor; pregnancy; soluble endoglin; soluble vascular endothelial growth factor receptor-1; ELEVATED LIVER-ENZYMES; GROWTH-FACTOR RECEPTOR-1; LOW PLATELET COUNT; SERUM URIC-ACID; GESTATIONAL HYPERTENSION; SOLUBLE ENDOGLIN; MATERNAL COMPLICATIONS; EARLY-ONSET; ELECTROCHEMILUMINESCENCE IMMUNOASSAY; INTRAVASCULAR COAGULATION;
D O I
10.3109/14767058.2013.806905
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective: To prospectively determine the prognostic value of maternal plasma concentrations of placental growth factor (PlGF), soluble endoglin (sEng) and soluble vascular endothelial growth factor receptors-1 and -2 (sVEGFR-1 and -2) in identifying patients with suspected preeclampsia (PE), who require preterm delivery (PTD) or develop adverse outcomes. Study design: This prospective cohort study included 85 consecutive patients who presented to the obstetrical triage area at 20-36 weeks with a diagnosis of "rule out PE." Patients were classified as: 1) those who remained stable until term (n = 37); and 2) those who developed severe PE and required PTD (n = 48). Plasma concentrations of PlGF, sEng and sVEGFR-1 and -2 were determined by ELISA. Results: Patients with PlGF/sVEGFR-1 <= 0.05 multiples of the median (MoM) or PlGF/sEng <= 0.07 MoM were more likely to deliver preterm due to PE [adjusted odd ratio (aOR) 7.4 and 8.8], and to develop maternal (aOR 3.7 and 2.4) or neonatal complications (aOR 10.0 and 10.1). Among patients who presented <34 weeks of gestation, PlGF/sVEGFR-1 <= 0.035 MoM or PlGF/sEng <= 0.05 MoM had a sensitivity of 89% (16/18), specificity of 96% (24/25) and likelihood ratio for a positive test of 22 to identify patients who delivered within 2 weeks. The addition of the PlGF/sVEGFR-1 ratio to standard clinical tests improved the sensitivity at a fixed false-positive rate of 3% (p = 0.004) for the identification of patients who were delivered due to PE within 2 weeks. Among patients who had a plasma concentration of PlGF/sVEGFR-1 ratio <= 0.035 MoM, 0.036-0.34 MoM and >= 0.35 MoM, the rates of PTD <34 weeks were 94%, 27% and 7%, respectively. Conclusions: The determination of angiogenic/anti-angiogenic factors has prognostic value in patients presenting to the obstetrical triage area with suspected PE for the identification of those requiring preterm delivery and at risk for adverse maternal/neonatal outcomes.
引用
收藏
页码:132 / 144
页数:13
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