First trimester placental growth factor and soluble Fms-like tyrosine kinase 1 and risk for preeclampsia
First trimester placental growth factor and soluble Fms-like tyrosine kinase 1 and risk for preeclampsia
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DOI：
10.1210/jc.2003-031244
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发表时间：
2004-02-01
影响因子：
5.8
通讯作者：
Karumanchi, SA
中科院分区：
文献类型：
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作者：
Thadhani, R;Mutter, WP;Karumanchi, SA
促血管生成因子和抗血管生成因子的失衡可能导致子痫前期(PE)。在这项前瞻性嵌套病例对照研究中，我们调查了胎盘生长因子(PlGF)及其可溶性抑制物可溶性FMS样酪氨酸激酶1(SFlt1)的早期妊娠血清水平，以区分发生PE(n=40)与妊娠期高血压(n=40)、小于胎龄儿(SGA)新生儿(n=40)或完成足月正常妊娠(n=80)的妇女。与对照组相比，发生PE(2+/-24pg/mlvs.63+/-145pg/ml；P<；0.01)或妊娠期高血压(27+/-19pg/ml；P=0.03)或分娩SGA新生儿(21+/-16pg/ml；P<；0.01)的孕妇血清PlGF水平较低。相反，血清sFlt1水平在两组间无显著差异：PE，1048+/-657pg/ml；妊娠期高血压，942+/-437pg/ml；SGA新生儿，1011+/-479pg/ml；正常对照组，973+/-490pg/ml。多变量分析表明，调整潜在混杂因素和血清sFlt1水平的多变量分析显示，与对照组相比，血清PlGF水平每降低一个对数单位，发生PE的风险增加3.7倍(95%可信区间，1.2-12.5)。对妊娠期高血压和SGA的分析没有显著意义。第三组(12pg/ml)与第一组(39pg/ml)相比，发生PE的风险增加了28.7倍(95%可信区间，2.3-351.0)。妊娠早期血清PlGF和sFlt1水平可确定为PE的高危人群。
An imbalance of pro- and antiangiogenic factors may lead to preeclampsia (PE). In this prospective nested case-control study, we investigated whether first trimester serum levels of placental growth factor (PlGF), a potent angiogenic factor, and its soluble inhibitor, soluble fms-like tyrosine kinase 1 (sFlt1), distinguished women who developed PE (n = 40) from those who developed gestational hypertension (n = 40), delivered a small for gestational age (SGA) newborn (n = 40), or completed a full term normal pregnancy (n = 80). Compared with controls, serum PlGF levels were lower among women who developed PE (2 +/- 24 pg/ml vs. 63 +/- 145 pg/ml; P < 0.01) or gestational hypertension (27 +/- 19 pg/ml; P = 0.03), or who delivered a SGA newborn (21 +/- 16 pg/ml; P < 0.01). In contrast, serum sFlt1 levels did not markedly differ between the groups: PE, 1048 +/- 657 pg/ml; gestational hypertension, 942 +/- 437 pg/ml; SGA newborns, 1011 +/- 479 pg/ml; and normal controls, 973 +/- 490 pg/ml. Multivariable analysis adjusting for potential confounders and serum sFlt1 levels demonstrated a 3.7-fold (95% confidence interval, 1.2-12.5) increase in risk for PE for every log unit decrease in serum levels of PlGF compared with controls. Analyses for gestational hypertension and SGA were not significant. Examined in tertiles, the risk for PE was increased 28.7-fold (95% confidence interval, 2.3-351.0) in the third (< 12 pg/ml) compared with the first (>39 pg/ml) PlGF tertile. First trimester serum levels of PlGF and sFlt1 may identify women at high risk for PE.