Low placental growth factor across pregnancy identifies a subset of women with preterm preeclampsia: type 1 versus type 2 preeclampsia?
Low placental growth factor across pregnancy identifies a subset of women with preterm preeclampsia: type 1 versus type 2 preeclampsia?
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DOI：
10.1161/hypertensionaha.112.191213
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发表时间：
2012-07
期刊：
影响因子：
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通讯作者：
Gandley RE
中科院分区：
文献类型：
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作者：
Powers RW;Roberts JM;Plymire DA;Pucci D;Datwyler SA;Laird DM;Sogin DC;Jeyabalan A;Hubel CA;Gandley RE
先兆子痫是一种异质性综合征，影响3-5%的妊娠。抗和促血管生成因子，可溶性受体样酪氨酸激酶1 （sFLT1）和胎盘生长因子（PGF）的失衡被认为有助于子痫前期的病理生理。在130名子痫前期患者和342名血压正常者分娩时的横断面样本中，以及50名子痫前期患者和250名血压正常者的纵向样本中，通过特异性免疫分析法对产妇血浆PGF和sFLT1进行定量分析。在发生先兆子痫的妇女中，46% （n=23）的孕妇在妊娠期间的PGF持续较低，低于对照组从妊娠15周到足月的95%置信区间。相比之下，其余54% （n=27）发生子痫前期的妇女的母体PGF浓度与正常对照组相似或高于正常对照组（n=7）。妊娠期间PGF低的子痫前期患者与PGF高的子痫前期患者相比，妊娠早期血压明显升高（p<0.05），诊断后分娩时胎龄更早（p<0.05），早产发生率更高（p<0.05）。在子痫前期的妇女中，有相当一部分人在怀孕期间PGF一直很低。与高PGF子痫前期患者相比，低PGF子痫前期患者与早产相关。确定妊娠期血浆PGF持续低的妇女可能有助于更好地了解子痫前期的病理生理，并可能提供更有针对性的研究和临床活动。
Preeclampsia is a heterogeneous syndrome affecting 3–5% of all pregnancies. An imbalance of the anti and pro-angiogenic factors, soluble receptor fms-like tyrosine kinase 1 (sFLT1) and placental growth factor (PGF), are thought to contribute to the pathophysiology of preeclampsia. Maternal plasma PGF and sFLT1 were quantified by specific immunoassays in cross-sectional samples from 130 preeclamptic subjects and 342 normotensive controls at delivery, and longitudinally in samples from 50 women who developed preeclampsia and 250 normotensive controls. Among women who developed preeclampsia, 46% (n=23) evidenced a pattern of consistently low maternal PGF across pregnancy below the lower 95%CI of controls from 15 weeks gestation to term. In contrast, the remaining 54% (n=27) women who developed preeclampsia had maternal PGF concentrations similar to or above (n=7) those of normotensive controls. Subjects with low PGF across pregnancy who developed preeclampsia evidenced significantly higher blood pressure in early pregnancy (p<0.05), and after diagnosis, earlier gestational age at delivery (p<0.05), and more preterm birth (p<0.05) compared to preeclamptic patients with high PGF. A significant subset of women who develop preeclampsia evidence consistently low PGF across pregnancy. Low PGF with preeclampsia was associated with preterm delivery compared to preeclamptic patients with high PGF. Identifying women with consistently low plasma PGF during pregnancy may provide a greater understanding of preeclampsia pathophysiology, and may provide more focused research and clinical activities.