Microvascular Remodelling in Preeclampsia: Quantifying Capillary Rarefaction Accurately and Independently Predicts Preeclampsia
Microvascular Remodelling in Preeclampsia: Quantifying Capillary Rarefaction Accurately and Independently Predicts Preeclampsia
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DOI：
10.1093/ajh/hpt087
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发表时间：
2013-09-01
影响因子：
3.2
通讯作者：
Manyonda, Isaac T.
中科院分区：
文献类型：
--
作者：
Antonios, Tarek F. T.;Nama, Vivek;Manyonda, Isaac T.
先兆子痫是孕产妇和新生儿死亡和发病的主要原因。先兆子痫的发病率似乎在上升，因为易患病的疾病，如原发性高血压，糖尿病和肥胖症的患病率增加，并且有越来越多的证据表明先兆子痫发作前广泛的微循环异常。我们假设，量化毛细血管稀疏可能有助于临床预测先兆子痫. METHODS我们测量皮肤毛细血管密度根据一个良好的验证协议在5个连续的预定访问在322个连续的白色妇女，其中16名受试者发展先兆子痫. METHODS我们发现，在20-24周的结构毛细血管稀疏，妊娠产生的灵敏度为0.87，特异性为0.50，截止值为2个毛细血管/视野，受试者操作特征值的曲线下面积为0.70，而妊娠27-32周时毛细血管稀疏在8个毛细血管/视野的截止值处产生0.75的灵敏度和0.77的更高特异性，接收器操作特征值的曲线下面积为0.82。结合毛细血管稀疏和子宫动脉多普勒搏动指数增加了预测的敏感性和特异性。多变量分析表明，先兆子痫的几率增加的妇女与先兆子痫或慢性高血压的既往病史，并在那些增加子宫动脉多普勒搏动指数，但最强大的和独立的先兆子痫的预测是毛细血管稀疏在27-32 weeks. CONCLUSIONsQuantitizing结构稀疏的皮肤毛细血管在怀孕是一个潜在的有用的临床指标先兆子痫的预测。
BACKGROUNDPreeclampsia is a major cause of maternal and neonatal mortality and morbidity. The incidence of preeclampsia seems to be rising because of increased prevalence of predisposing disorders, such as essential hypertension, diabetes, and obesity, and there is increasing evidence to suggest widespread microcirculatory abnormalities before the onset of preeclampsia. We hypothesized that quantifying capillary rarefaction could be helpful in the clinical prediction of preeclampsia.METHODSWe measured skin capillary density according to a well-validated protocol at 5 consecutive predetermined visits in 322 consecutive white women, of whom 16 subjects developed preeclampsia.RESULTSWe found that structural capillary rarefaction at 20-24 weeks of, gestation yielded a sensitivity of 0.87 with a specificity of 0.50 at the cutoff of 2 capillaries/field with the area under the curve of the receiver operating characteristic value of 0.70, whereas capillary rarefaction at 27-32 weeks of gestation yielded a sensitivity of 0.75 and a higher specificity of 0.77 at the cutoff of 8 capillaries/field with area under the curve of the receiver operating characteristic value of 0.82. Combining capillary rarefaction with uterine artery Doppler pulsatility index increased the sensitivity and specificity of the prediction. Multivariable analysis shows that the odds of preeclampsia are increased in women with previous history of preeclampsia or chronic hypertension and in those with increased uterine artery Doppler pulsatility index, but the most powerful and independent predictor of preeclampsia was capillary rarefaction at 27-32 weeks.CONCLUSIONSQuantifying structural rarefaction of skin capillaries in pregnancy is a potentially useful clinical marker for the prediction of preeclampsia.