胎盘生长因子、可溶性fms样酪氨酸激酶-1及糖基化纤连蛋白在子痫前期预测中的应用价值

Application value of placental growth factor，soluble fms-like tyrosine kinase-1，and glycosylated fibronectin in the prediction of preeclampsia

摘要:

目的 探讨胎盘生长因子（placental growth factor，PLGF）、可溶性fms样酪氨酸激酶-1（soluble fms-like tyrosine kinase-1，SFLT-1）和糖基化纤连蛋白（glycosylated fibronectin，GLYFN）检测对子痫前期的预测价值。方法 选择在无锡市妇幼保健院就诊的188例孕妇，分154例正常孕妇（对照组）和34例子痫前期患者（子痫组），应用免疫荧光法分别检测其在孕16~18周血清中PLGF、SFLT-1和GLYFN的浓度，比较子痫前期组和对照组各标志物的水平，并使用受试者操作特征曲线（receiver operating characteristic，ROC）对3种标志物的预测价值进行效能评估。结果 在妊娠中期，子痫前期组血清PLGF浓度低于对照组，SFLT-1及GLYFN浓度均高于对照组，3种标志物的差异均有统计学意义（3指标P=0.000）。95%置信区间的ROC曲线下面积（areas under the ROC curve，AUC）为，PLGF为0.941（0.907~0.974），SFLT-1为0.881（0.800~0.962），GLYFN为0.951（0.918~0.985），联合指标SFLT-1和GLYFN、3项指标联合检测在ROC曲线下面积（areas under the ROC curve，AUC）分别为0.968、0.986。结论 PLGF、SFLT-1、GLYFN 3种标志物水平在对照组和子痫前期组均存在明显差异，对子痫前期的发病具有一定的预测价值，SFLT-1联合PLGF、SFLT-1联合GLYFN、3项指标联合检测对子痫前期的预测价值高于任一单项指标。

Abstract:

Objective To explore the value of placental growth factor（PLGF），soluble fms-like tyrosine kinase-1（SFLT-1），and glycosylated fibronectin（GLYFN） in predicting preeclampsia.Methods A total of 188 pregnant women who visited Wuxi Maternal and Child Health Hospital were enrolled in the study and divided into control group（154 normal pregnant women） and preeclampsia group（34 patients with preeclampsia）. The concentrations of serum PLGF，SFLT-1，and GLYFN at the 16th to 18th weeks of gestation were measured by immunofluorescence assay. The levels of individual markers were compared between the preeclampsia group and the control group. The receiver operating characteristic（ROC） curves were used to assess the efficiency of the three markers in terms of predictive value.Results During the mid-pregnancy period，the preeclampsia group had a significantly lower concentration of serum PLGF but significantly higher concentrations of serum SFLT-1 and GLYFN compared with the control group（all P=0.000）. The areas under the ROC curve（AUC） for the 95% confidence interval were 0.941（0.907-0.974），0.881（0.800-0.962），and 0.951（0.918-0.985） for PLGF，SFLT-1，and GLYFN，respectively. The AUCs for SFLT-1 combined with GLYFN and the combined detection of the three indices were 0.968 and 0.986，respectively.Conclusion There are significant differences between the control group and the preeclampsia group in the marker levels of serum PLGF，SFLT-1，and GLYFN，which has some value in predicting the onset of preeclampsia. The predictive value of SFLT-1 combined with PLGF，SFLT-1 combined with GLYFN，and the combination of the three markers are greater than that of any single index.