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目的探讨孕妇血浆中可溶性血管内皮生长因子受体1(sFlt-1)水平变化对子痫前期发病的早期预测价值。方法采用前瞻性研究方法,应用酶联免疫吸附试验(ELISA)对146例妊娠20～26周最初血压正常孕妇的血浆中 sFh-1水平进行测定,并随访观察孕妇血压变化和妊娠结局。结果 (1)146例孕妇中,发展为子痫前期患者12例(子痫前期组),余134例孕妇妊娠结局正常(正常妊娠组)。(2)子痫前期组孕妇血浆 sFlt-1水平为(4135±699)ng/L,正常妊娠组为(1490±1033)ng/L,两组比较,差异有统计学意义(P<0.01)。子痫前期组患者临床诊断前10周即出现sFh-1水平升高。(3)sFlt-1水平预测子痫前期,受试者工作曲线的曲线下面积为0.981。以 sFlt-1≥3344 ng/L 为切点,预测子痫前期的敏感度、特异度、阳性预测值及阴性预测值分别为100%、96%、67%、100%。结论子痫前期患者血浆 sFlt-1水平升高的变化早于临床诊断子痫前期10周以上,因此,血浆 sFh-1水平变化可作为子痫前期发病的早期预测指标。
Objective To investigate the early predictive value of sFlt-1 in maternal plasma on the incidence of preeclampsia. Methods A prospective study was conducted to determine the plasma level of sFh-1 in 146 cases of normotensive pregnant women with initial normotensive pregnancies from 20 weeks to 26 weeks by enzyme-linked immunosorbent assay (ELISA). The changes of blood pressure and pregnancy outcome were observed. Results (1) Of the 146 pregnant women, 12 cases developed preeclampsia (preeclampsia group) and 134 cases had normal pregnancy (normal pregnancy group). (2) The serum level of sFlt-1 in pregnant women with preeclampsia was (4135 ± 699) ng / L and that in normal pregnancy was (1490 ± 1033) ng / L, the difference was statistically significant (P <0.01) . In patients with preeclampsia, sFh-1 levels increased 10 weeks before clinical diagnosis. (3) sFlt-1 level predicted preeclampsia, subjects under the curve of the area under the curve was 0.981. The sensitivity, specificity, positive predictive value and negative predictive value of predicting preeclampsia with sFlt-1≥3344 ng / L as cut-off points were 100%, 96%, 67% and 100% respectively. Conclusions The change of plasma sFlt-1 level in preeclampsia is earlier than that in clinical diagnosis of preeclampsia. Therefore, the change of plasma sFh-1 levels can be used as an early predictor of preeclampsia.