Plasma concentrations of soluble endoglin versus standard evaluation in patients with suspected preeclampsia.
Plasma concentrations of soluble endoglin versus standard evaluation in patients with suspected preeclampsia.
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DOI：
10.1371/journal.pone.0048259
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Karumanchi SA
中科院分区：
文献类型：
--
作者：
Rana S;Cerdeira AS;Wenger J;Salahuddin S;Lim KH;Ralston SJ;Thadhani RI;Karumanchi SA
本研究的目的是将血浆可溶性内皮糖蛋白 (sEng) 水平与标准临床评估或其他血管生成蛋白 [可溶性 fms 样酪氨酸激酶 1 (sFlt1) 和胎盘生长因子 (PlGF)] 的血浆水平进行比较，以预测 34 周前疑似先兆子痫的女性的短期不良孕产妇和围产期结局。本分析纳入了所有在 <34 周时评估单胎妊娠先兆子痫的女性（2009 年 7 月至 2010 年 10 月）的数据，并在就诊时测量了 sEng 水平。对 170 次分类遭遇的数据进行了分析，并以中位数 {25−75th centile} 的形式呈现。百分之三十三的患者（170 名患者中的 56 名）经历了不良结果。与未经历不良后果的患者相比，随后经历不良后果的患者的 sEng 水平 (ng/ml) 显着升高（32.3 {18.1, 55.8} vs 4.8 {3.2, 8.6}，p<0.0001）。在假阳性率为 10% 的情况下，sEng 的不良结果检出率高于最高收缩压、蛋白尿和异常实验室测试组合的不良结果检出率（分别为 80.4 {70.0, 90.8} vs 63.8 {51.4, 76.2}）。与最低四分位数的受试者相比，sEng 最高四分位数的受试者更有可能提前分娩（HR：14.96 95% CI：8.73−25.62，p<0.0001）。自然对数转换的 sEng 与 log sFlt1 水平呈正相关 (r = 0.87)，与 log PlGF 水平呈负相关 (r = −0.79)（两者均 p<0.0001）。血浆 sEng 具有与 sFlt1/PlGF 比率测量结果相当的预测不良结果的曲线下面积（sEng 为 0.88 {0.81, 0.95}，sFlt1/PlGF 比率为 0.89 {0.83, 0.95}，p = 0.74）。在妊娠 34 周之前出现疑似先兆子痫的女性中，sEng 在检测两周内发生的不良母体和胎儿结局方面表现优于标准临床评估。可溶性内皮糖蛋白与 sFlt1 和 PlGF 水平密切相关，表明导致先兆子痫的常见致病途径。
The purpose of this study was to compare plasma soluble endoglin (sEng) levels with standard clinical evaluation or plasma levels of other angiogenic proteins [soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF)] in predicting short-term adverse maternal and perinatal outcomes in women with suspected preeclampsia presenting prior to 34 weeks. Data from all women presenting at <34 weeks for evaluation of preeclampsia with singleton pregnancies (July 2009−October 2010) were included in this analysis and sEng levels were measured at presentation. Data was analyzed for 170 triage encounters and presented as median {25−75th centile}. Thirty-three percent of patients (56 of 170) experienced an adverse outcome. sEng levels (ng/ml) were significantly elevated in patients who subsequently experienced adverse outcomes compared to those who did not (32.3 {18.1, 55.8} vs 4.8 {3.2, 8.6}, p<0.0001). At a 10% false positive rate, sEng had higher detection rates of adverse outcomes than the combination of highest systolic blood pressure, proteinuria and abnormal laboratory tests (80.4 {70.0, 90.8} vs 63.8 {51.4, 76.2}, respectively). Subjects in the highest quartile of sEng were more likely to deliver early compared to those in the lowest quartile (HR: 14.96 95% CI: 8.73−25.62, p<0.0001). Natural log transformed sEng correlated positively with log sFlt1 levels (r = 0.87) and inversely with log PlGF levels (r = −0.79) (p<0.0001 for both). Plasma sEng had comparable area under the curve for prediction of adverse outcomes as measurement of sFlt1/PlGF ratio (0.88 {0.81, 0.95} for sEng versus 0.89 {0.83, 0.95} for sFlt1/PlGF ratio, p = 0.74). In women with suspected preeclampsia presenting prior to 34 weeks of gestation, sEng performs better than standard clinical evaluation in detecting adverse maternal and fetal outcomes occurring within two weeks of presentation. Soluble endoglin was strongly correlated with sFlt1 and PlGF levels, suggesting common pathogenic pathways leading to preeclampsia.