Implementation of the sFlt-1/PlGF ratio for prediction and diagnosis of pre-eclampsia in singleton pregnancy: implications for clinical practice.
Implementation of the sFlt-1/PlGF ratio for prediction and diagnosis of pre-eclampsia in singleton pregnancy: implications for clinical practice.
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DOI：
10.1002/uog.14799
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发表时间：
2015-03
影响因子：
7.1
通讯作者：
Galindo, A.
中科院分区：
文献类型：
--
作者：
Stepan, H.;Herraiz, I.;Schlembach, D.;Verlohren, S.;Brennecke, S.;Chantraine, F.;Klein, E.;Lapaire, O.;Llurba, E.;Ramoni, A.;Vatish, M.;Wertaschnigg, D.;Galindo, A.
先兆子痫（PE）是全球孕产妇和胎儿/新生儿发病率和死亡率的主要原因。PE的临床诊断和定义通常基于非特异性体征和症状的测量，主要是高血压和蛋白尿a1 - 3。然而，由于认识到蛋白尿的测量容易不准确，而且PE并发症经常在蛋白尿变得明显之前发生，最近的指南也支持在高血压和母体器官功能障碍的迹象基础上诊断PE，而不是蛋白尿3 - 5。此外，PE的临床表现和病程是多变的，从严重和快速进展的早发性PE，需要早产，到足月迟发性PE。可能存在相关的宫内生长限制（IUGR），进一步增加新生儿发病率和死亡率。这些特征表明，诊断PE的经典标准不足以涵盖该综合征的复杂性。毫无疑问，对PE高风险孕妇的适当管理需要早期可靠的检测和加强监测，并转诊到专门的围产期护理中心，以大幅降低孕产妇、胎儿和新生儿的发病率6,7。自Maynard等人8报道胎盘过量产生可溶性纤维样酪氨酸激酶受体-1 (sFlt-1)，一种血管内皮生长因子和胎盘生长因子（PlGF）的拮抗剂，有助于PE的发病机制以来的十年中，大量的研究已经发表，证明血管生成标志物在PE和胎盘相关疾病的诊断和后续预测和管理方面的有用性。各种报道表明，血管生成和抗血管生成因子的紊乱与PE的发病机制有关，并可能与该病的诊断和预后有关。血清sFlt-1水平升高，PlGF水平降低，从而导致sFlt-1/PlGF比值升高，可在诊断为PE和IUGR或死产（即胎盘相关疾病）的妇女妊娠后半期检测到。这些改变在早发性疾病中比晚发性疾病更明显，并且与临床疾病的严重程度有关。此外，据报道，血管生成因子的紊乱在出现临床症状（疾病）之前就可以检测到，从而可以将正常妊娠的妇女与发生妊娠并发症（主要是PE9-30）的高风险妇女区别开来。血管生成/抗血管生成因子的血浆浓度在产科分诊中具有预后价值：类似于在早发性PE妇女中观察到的逐渐恶化的临床过程，可以发现血管生成谱的变化导致更抗血管生成状态。目前PE的定义在预测PE相关不良后果方面很差。基于血压和蛋白尿的PE诊断在预测PE相关不良后果方面有大约30%的阳性预测值31。估计sFlt-1/PlGF比率可以识别即将分娩和不良孕产妇和新生儿结局的高风险妇女23,30,32 - 35。此外，也有研究表明，重复测量之间的sFlt-1/PlGF比值的时间依赖性斜率可预测妊娠结局和发生PE的风险，因此建议重复测量36。然而，随访检查的“最佳”时间间隔仍不清楚。最后，高价值与交付的需求密切相关……
Pre-eclampsia (PE) is a leading cause of maternal and fetal/neonatal morbidity and mortality worldwide. Clinical diagnosis and definition of PE is commonly based on the measurement of non-specific signs and symptoms, principally hypertension and proteinuria1–3. However, due to the recognition that measurement of proteinuria is prone to inaccuracies and the fact that PE complications often occur before proteinuria becomes significant, most recent guidelines also support the diagnosis of PE on the basis of hypertension and signs of maternal organ dysfunction other than proteinuria3–5. Furthermore, the clinical presentation and course of PE is variable, ranging from severe and rapidly progressing early-onset PE, necessitating preterm delivery, to late-onset PE at term. There may be associated intrauterine growth restriction (IUGR), further increasing neonatal morbidity and mortality. These features suggest that the classical standards for the diagnosis of PE are not sufficient to encompass the complexity of the syndrome. Undoubtedly, proper management of pregnant women at high risk for PE necessitates early and reliable detection and intensified monitoring, with referral to specialized perinatal care centers, to reduce substantially maternal, fetal and neonatal morbidity6, 7. In the decade since Maynard et al. 8 reported that excessive placental production of soluble fms-like tyrosine kinase receptor-1 (sFlt-1), an antagonist of vascular endothelial growth factor and placental growth factor (PlGF), contributes to the pathogenesis of PE, extensive research has been published demonstrating the usefulness of angiogenic markers in both diagnosis and the subsequent prediction and management of PE and placentarelated disorders. Various reports have demonstrated that disturbances in angiogenic and antiangiogenic factors are implicated in the pathogenesis of PE and have possible relevance in the diagnosis and prognosis of the disease. Increased serum levels of sFlt-1 and decreased levels of PlGF, thereby resulting in an increased sFlt-1/PlGF ratio, can be detected in the second half of pregnancy in women diagnosed to have not only PE but also IUGR or stillbirth, ie placenta-related disorders. These alterations are more pronounced in early-onset rather than late-onset disease and are associated with severity of the clinical disorder. Moreover, the disturbances in angiogenic factors are reported to be detectable prior to the onset of clinical symptoms (disease), thereby allowing discrimination of women with normal pregnancies from those at high risk for developing pregnancy complications, primarily PE9–30.Plasma concentrations of angiogenic/antiangiogenic factors are of prognostic value in obstetric triage: similar to the progressively worsening clinical course observed in women with early-onset PE, changes in the angiogenic profile leading to a more antiangiogenic state can be found. Current definitions of PE are poor in predicting PE-related adverse outcomes. A diagnosis of PE based on blood pressure and proteinuria has a positive predictive value of approximately 30% for predicting PE-related adverse outcomes31. Estimation of the sFlt-1/PlGF ratio allows identification of women at high risk for imminent delivery and adverse maternal and neonatal outcome23, 30, 32–35. Moreover, it has also been shown that the time-dependent slope of the sFlt-1/PlGF ratio between repeated measurements is predictive for pregnancy outcome and the risk of developing PE, and repeated measurements have been suggested36. However, the ‘optimal’time interval for a follow-up test remains unclear. Finally, high values are closely related to the need to deliver …
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影响因子：
7.2
作者：
Herraiz, Ignacio;Droege, Lisa Antonia;Verlohren, Stefan
通讯作者：
Verlohren, Stefan
DOI：
10.3109/14767058.2013.806905
发表时间：
2014-01
期刊：
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
影响因子：
--
作者：
Chaiworapongsa T;Romero R;Korzeniewski SJ;Cortez JM;Pappas A;Tarca AL;Chaemsaithong P;Dong Z;Yeo L;Hassan SS
通讯作者：
Hassan SS
DOI：
10.3109/14767058.2011.589932
发表时间：
2011-10-01
影响因子：
1.8
作者：
Chaiworapongsa, Tinnakorn;Romero, Roberto;Hassan, Sonia S.
通讯作者：
Hassan, Sonia S.
影响因子：
9.8
作者：
Espinoza, Jimmy;Romero, Roberto;Gonzalez, Rogelio
通讯作者：
Gonzalez, Rogelio
影响因子：
9.8
作者：
Bode, MM;O'Shea, TM;Stiles, AD
通讯作者：
Stiles, AD