Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia
Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia
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DOI：
10.1056/nejmoa1414838
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发表时间：
2016-01-07
影响因子：
158.5
通讯作者：
Verlohren, Stefan
中科院分区：
文献类型：
--
作者：
Zeisler, Harald;Llurba, Elisa;Verlohren, Stefan
背景在孕妇的临床临床开始之前，孕妇的可溶性FMS样酪氨酸激酶1（SFLT-1）与胎盘生长因子（PLGF）的比率升高，但其对怀疑先兆子痫的女性的预测价值不清楚。 ，多中心，观察性研究，以得出和验证血清SFLT-1与PLGF的比率可预测怀疑先兆子痫的单身女性在短期内缺乏先兆子痫（24周0天到36周6天的妊娠6天）。主要目标是评估低SFLT-1：PLGF比率（在衍生截止值下方或以下）是否可以预测在第一次访问后1周内不存在先兆子痫的不存在，并且高比率（高于截止）是否可以预测4周内的前启示性存在。在开发队列（500名女性）中，我们确定SFLT-1：PLGF比率为38的sflt-1：具有重要的预测价值。在另外550名妇女的随后验证研究中，SFLT-1：38或更低的SFLT-1：PLGF比率为99.3％（95％置信区间[CI]，在后一周内没有先兆子痫的负值值（即，在后续一周内没有先兆子痫）。至99.9），具有80.0％的敏感性（95％CI，51.9至95.7）和78.3％的特异性（95％CI，74.6至81.7）。 SFLT-1：PLGF比在4周内诊断前斜率高于38的阳性预测值为36.7％（95％CI，28.4至45.7），敏感性为66.2％（95％CI，54.0至77.0）和83.1 ％特异性（95％CI，79.4至86.3）.conclusionsan sflt-1：PLGF 38或更低的比率可用于预测怀疑该综合征在临床上怀疑该综合征的女性的短期缺失。 （由Roche Diagnostics资助。）
BACKGROUNDThe 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.METHODSWe 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 singleton pregnancies in whom preeclampsia was suspected (24 weeks 0 days to 36 weeks 6 days of gestation). Primary objectives were to assess whether low sFlt-1:PlGF ratios (at or below a derived cutoff) predict the absence of preeclampsia within 1 week after the first visit and whether high ratios (above the cutoff) predict the presence of preeclampsia within 4 weeks.RESULTSIn the development cohort (500 women), we identified an sFlt-1:PlGF ratio cutoff 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 to 86.3).CONCLUSIONSAn 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. (Funded by Roche Diagnostics.)