Prospective study for detecting risk factors ineluding serum placental growth factor (PIGT) for the occurrence ofearly onset preeclampsia

我们在2003年4月至2008年3月期间检测了1500名妊娠16至23周的孕妇的子宫动脉血流速度波形。分别于孕20~23周、28~29周和37周分别采集1358、916和365例孕妇的血10m1，离心后将血清和血浆保存于-20℃，直至检测胎盘生长因子(PlGF)和可溶性FMS样酪氨酸激酶1(sFlt-1)。在两年的时间里，我们取得了以下3个主要成果。我们调查了587名孕妇，并探讨了妊娠20周左右子宫血流速度波形的高切迹深度指数(NDI)和妊娠20周左右的血压水平对子痫前期晚期发生的影响。高NDI和存在高血压前期(&gt；130/85 mm Hg)/高血压的敏感性分别为53%和63%。这两个标记的联合使用导致了敏感度的提高(84%)2。我们调查了261个单态…孕16~23周检测子宫动脉血流速度波形，孕16~23周和27~29周两次检测血清P1GF和sFlt-1水平的孕妇较多。妊娠中期NDI高的孕妇血清P1GF水平显著低于正常妊娠组。此外，高NDI低P1GF组妊娠28周左右sFlt-1高水平的发生率显著高于低NDI高P1GF组、低NDI低P1GF组、高NDI高P1GF组和高NDI高P1GF组。对85例正常妊娠妇女分别于孕20~23周、27~29周和36~38周采血3次，建立孕20~38周血清可溶性内毒素(Seng)正常参考值。结果发现，所有早发型子痫前期妇女(25/25)均表现出较高的SIN值(≧为妊娠期SING参考值范围的95%)，而所有较晚发生早发型子痫前期的妇女(5/5)在妊娠16~23周均表现出较高的SIN值。较少

We examined uterine artery flow velocity waveforms in 1500 pregnant women at 16 to 23 weeks of gestation, during April 2003 to March 2008. We also took 10m1 of blood from 1358, 916 and 365 pregnant women at 20 to 23, 28 to 29, and 37 weeks of gestation, respectively, and centrifuged the blood, and stored the serums and plasmas at -20 C until the examination of placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1). We obtained the following 3 main results during 2 years.1. We investigated 587 pregnant cohorts, and examined the effects of the high notch depth index (NDI) of the uterine flow velocity waveforms around 20 weeks of gestation and blood pressure levels around 20 week of gestation on the later occurrence of preeclampsia. The sensitivities of high NDI and the existence of prehypertension (>130/85 mmHg)/hypertension were 53% and 63%, respectively. The combination of both markers resulted in the increase of sensitivity (84%)2. We investigated 261 singleton … More pregnant cohorts, who were examined uterine artery flow velocity waveforms at 16 to 23 weeks of gestation, and in whom serum levels of P1GF and sFlt-1 twice at both 16 to 23 and 27 to 29 weeks of gestation. In women with high NDI at mid-gestation, the serum levels of P1GF were significantly low. In addition, the incidence rates of high sFlt-1 levels at around 28 weeks of gestation and the later occurrence of preeclampsia were significantly higher in women with both high NDI and low P1GF levels, than those with both low NDI and high P1GF, those with both low NDI and low P1GF, and those with both high NDI and high P1GF, respectively.3. We established the normal reference values of serum soluble endoglin (sEng) from 20 to 38 weeks of gestation, using serums taken three times at 20 to 23, 27 to 29 and 36 to 38 weeks of gestation in 85 normal pregnant women. We found that all the women (25/25) with early onset preeclampsia showed high sEng (≧ 95% of the reference ranges of sEng during pregnant period), and all the women (5/5) with later occurrence of early onset preeclampsia showed high sEng at 16 to 23 weeks of gestation. Less