First-Trimester Placental Growth Factor for the Prediction of Preeclampsia in Nulliparous Women: The Great Obstetrical Syndromes Cohort Study
First-Trimester Placental Growth Factor for the Prediction of Preeclampsia in Nulliparous Women: The Great Obstetrical Syndromes Cohort Study
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DOI：
10.1159/000487301
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发表时间：
2019-01-01
影响因子：
2.2
通讯作者：
Bujold, Emmanuel
中科院分区：
文献类型：
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作者：
Boutin, Amelie;Demers, Suzanne;Bujold, Emmanuel
背景：妊娠早期母体血清标志物与先兆子痫（PE）有关。我们的目的是评价妊娠早期胎盘生长因子（PlGF）预测未产妇PE的性能。研究对象和方法：我们对单胎妊娠11-13周的未经产妇女进行了一项前瞻性队列研究。使用BRAHMS PlGF plus KRYPTOR自动化测定法测量母体血清PlGF浓度，并以针对胎龄调整的中值的倍数报告。我们使用比例风险模型，沿着与受试者工作特征曲线和曲线下面积（AUC）。结果：在4,652名参与者中，我们观察到232例（4.9%）PE，包括202例（4.3%）足月PE和30例（0.6%）早产PE。PlGF与足月（AUC = 0.61，95%置信区间[CI] 0.57-0.65）和早产PE（AUC = 0.73，95%CI 0.64-0.83）的风险相关。通过添加母体特征，模型得到改善（足月PE的AUC 0.66，95% CI 0.62-0.71;早产PE的AUC 0.81，95% CI 0.72-0.91; p < 0.01）。在10%的假阳性率下，PlGF结合母体特征可以预测26%的足月PE和55%的早产PE。添加妊娠相关血浆蛋白A并没有显著改善预测模型。结论：孕早期PlGF结合母体特征对未产妇早产PE的预测有一定的参考价值。
Background: First-trimester maternal serum markers have been associated with preeclampsia (PE). We aimed to evaluate the performance of first-trimester placental growth factor (PlGF) for the prediction of PE in nulliparous women. Subjects and Methods: We conducted a prospective cohort study of nulliparous women with singleton pregnancy at 11-13 weeks. Maternal serum PlGF concentration was measured using BRAHMS PlGFplus KRYPTOR automated assays and reported in multiple of the median adjusted for gestational age. We used proportional hazard models, along with receiver operating characteristic curves and areas under the curve (AUC). Results: Out of 4,652 participants, we observed 232 (4.9%) cases of PE including 202 (4.3%) term and 30 (0.6%) preterm PE. PlGF was associated with the risk of term (AUC = 0.61, 95% confidence interval [CI] 0.57-0.65) and preterm PE (AUC = 0.73, 95% CI 0.64-0.83). The models were improved with the addition of maternal characteristics (AUC for term PE 0.66, 95% CI 0.62-0.71; AUC for preterm PE 0.81, 95% CI 0.72-0.91; p < 0.01). At a false-positive rate of 10%, PlGF combined with maternal characteristics could have predicted 26% of term and 55% of preterm PE. The addition of pregnancy-associated plasma protein A did not significantly improve the prediction models. Conclusion: First-trimester PlGF combined with maternal characteristics is useful to predict preterm PE in nulliparous women.