中孕期血清可溶性血管内皮生长因子受体1、胎盘生长因子水平及其比值筛查妊娠期高血压疾病的效率

目的探讨中孕期血清可溶性血管内皮生长因子受体1(sFlt-1)、胎盘生长因子(PlGF)水平以及sFlt-1/PlGF比值在妊娠期高血压(GH)和子痫前期(PE)的筛查效率。方法选取2014年7月-2016年8月在杭州市2家医院接受产前筛查的孕妇,根据分娩结局轻重程度,将研究对象分为GH组、PE组、重度子痫前期(SPE)组、对照组,检测4组孕妇血清sFlt-1和PlGF水平,并比较其浓度分布及sFlt-1/PlGF比值情况。用受试者工作特征(ROC)曲线确定最佳临界值(cut-off)、曲线下面积(AUC),对sFlt-1、PlGF水平及sFlt-1/PlGF比值的筛查效能进行评价。结果 GH组sFlt-1水平低于对照组,PE组、SPE组sFlt-1水平高于对照组,4组差异有统计学意义(P <0. 001);GH组PlGF水平高于对照组,PE组、SPE组PlGF水平低于对照组,4组差异有统计学意义(P <0. 001);GH组sFlt-1/PlGF比值低于对照组,PE组、SPE组sFlt-1/PlGF比值高于对照组,4组孕妇sFlt-1/PlGF比值差异有统计学意义(P=0. 001)。GH组血清sFlt-1、PlGF和sFlt-1/PlGF比值的AUC分别为0. 692、0. 725和0. 795;PE组的AUC分别为0. 838、0. 852和0. 864,SPE组的AUC分别为0. 714、0. 791和0. 771。结论 sFlt-1/PlGF比值筛查GH和PE的效率优于单独sFlt-1、PlGF的筛查效率,但对SPE的效率没有优于sFlt-1、PlGF的筛查效率。

Effectiveness of serum soluble vascular endothelial growth factor receptor 1,placental growth factor levels and their ratios in the screening of pregnancy-induced-hypertension

Objective To investigate the efficacy of serum soluble vascular endothelial growth factor receptor 1( sFlt-1),placental growth factor( PlGF) and the ratio of sFlt-1/PlGF in screening pregnancy-induced hypertension and preeclampsia.Methods From July 2014 to August 2016,pregnant women undergoing second trimester prenatal screening at two hospitals were selected. The subjects were divided into hypertension group during pregnancy,preeclampsia group,severe preeclampsia group,and the control group. The serum sFlt-1 and PlGF levels of four groups of pregnant women were detected,and their concentration distribution and sFlt-1/PlGF ratio were compared. The receiver operating characteristic( ROC) curve was used to determine the optimal cut-off value and area under the curve( AUC),and the screening effectiveness of sFlt-1,PlGF levels,and sFlt-1/PlGF ratio was evaluated. Results The results of sFlt-1 levels in the hypertension group during pregnancy were lower than those in the control group. The levels of sFlt-1 in the preeclampsia group and the severe preeclampsia group were higher than those in the control group,and there was statistical significance on the difference in sFlt-1 levels among the four groups( P < 0. 001);PlGF levels in the hypertensive group during pregnancy were higher than those in the control group,PlGF levels in the preeclampsia group and severe preeclampsia group were lower than those in the control group,and there was statistical significance on the difference in PlGF levels among the four groups( P < 0. 001);the ratio of sFlt-1/PlGF in the hypertensive group during pregnancy was lower than that in the control group,and the ratio of sFlt-1/PlGF in the preeclampsia group and severe preeclampsia group was higher than that in the control group. There was statistical significance on the difference in sFlt-1/PlGF ratio between groups( P = 0. 001). The AUC of serum sFlt-1,PlGF and sFlt-1/PlGF ratios in pregnancy-induced hypertension group was respectively 0. 692,0. 725,0. 795;the AUC of serum sFlt-1,PlGF,and sFlt-1/PlGF ratios in the second trimester was respectively 0. 838,0. 852,0. 864;the AUC of sFlt-1,PlGF,and sFlt-1/PlGF ratios of the pregnant women in the severe preeclampsia group was respectively 0. 714,0. 791,0. 771. Conclusion The Screening efficiency of sFlt-1/PlGF was better than that of sFlt-1 and PlGF in screening pregnancy-induced hypertension and preeclampsia.