摘要目的 探讨孕中期孕妇血清中胎盘生长因子(PlGF)和可溶性Fms样酪氨酸激酶1(sFlt-1)的水平及sFlt-1/PlGF比值变化在预测子痫前期发生中的价值.方法 选择2011年10月一2012年5月在北京协和医院及北京市海淀区妇幼保健院行常规产前检查并诊断为妊娠期高血压疾病的孕妇,分别为子痫前期组(41例)和妊娠期高血压组(44例)；同期单胎健康孕妇为对照组(88例).分别于孕15 ～ 20周和孕24～28周,采用电化学发光免疫分析法对3组孕妇血清中sFlt-1及PlGF水平进行检测,并计算sFlt-1/PlGF比值；计算预测发生子痫前期的敏感度和特异度.结果 (1)孕15 ～ 20周:子痫前期组孕妇血清中sFlt-1、PlGF水平分别为(1 658±488)、(141±80) μg/L,sFlt-1/PlGF比值为17 ±9；妊娠期高血压组分别为(1 945±575)、(143 ±52) μg/L及15 ±6,两组分别与对照组[分别为(2 084 ±741)、(65±58)μg/L及16±9]比较,差异均无统计学意义(P＞0.05).(2)孕24 ～ 28周:子痫前期组孕妇血清中sFlt-1、PlGF水平中位数分别为8 525、35 μg/L,sFlt-1/PlGF比值为398.0；妊娠期高血压组分别为905、336 μg/L及2.7；对照组分别为1 028、477μg/L及2.3；子痫前期组孕妇血清中sFlt-1、PlGF水平及sFlt-1/PlGF比值分别与对照组比较,差异有统计学意义(P＜0.01)；妊娠期高血压组孕妇血清中PlGF水平与对照组比较,差异有统计学意义(P＜0.01).(3)预测价值:取sFlt-1切割值为2 500 μg/L时,预测子痫前期的敏感度和特异度分别为93％和99％；取PlGF切割值为270 μg/L时,预测子痫前期的敏感度和特异度分别为92％和77％；取sFlt-1/PlGF比值的切割值为11,预测子痫前期的敏感度和特异度分别为89％和99％.结论 对孕24 ～28周孕妇血清中sFlt-1,PlGF水平进行检测并计算sFlt-1/PlGF比值,在预测子痫前期发生中有较好的临床价值.

abstractsObjective To study the value of second trimester maternal serum soluble Fms-like tyrosine kinase 1 (sFlt-1),placenta grouth factor (PlGF) and their ratio in the prediction of preeclampsia.Methods In this nested case-control study,we collected second trimester maternal serum samples at 15-20 weeks and 24-28 weeks of gestation from those who developed gestational hypertensive disorders.Maternal serum sFlt-1 and PlGF were measured by electrochemiluminescence immunoassay on an automated platform.The value of sFlt-1,PlGF and their ratio were compared between gestational hypertensive group and the control group.Results Totally 41 patients with preeclampsia,44 patients with gestational hypertension and 88 women with normal pregnancy outcomes were included in this study.There was no difference of age,gravidity,parity and preconception body mass index (BMI) between these three groups (P ＞0.05).Gestational week at delivery and neonatal birth weight were different between preeclampsia group and the control group (P ＜ 0.01).The mean value of sFlt-1,PlGF and sFlt-1/PlGF ratio was (1 658±488) μg/L,(141 ± 80) μg/L and 17 ± 9 in preeclampsia group,(1 945 ± 575) μg/L,(143 ±52) μg/L and 15 ±6 in gestational hypertension group,and (2 084 ±741) μg/L,(65 ±58) μg/L and 16 ±9 in the control group at 15-20 weeks of gestation.There was no difference of sFlt-1,PlGF value and their ratio among the three groups at 15-20 weeks of gestation(P ＞0.05).The median value of sFlt-1,PlGF and sFlt-1/PlGF ratio were 8 525 μg/L,35 μg/L and 398.0 in preeclampsia group,905 μg/L,336 μg/L and 2.7 in gestational hypertension group,1 028 μg/L,477 μg/L and 2.3 in the control group at 24-28 weeks of gestation.The value of sFlt-1,PlGF and their ratio was significantly different between preeclampsia group and the control group at 24-28 weeks of gestation(P ＜0.0l).PlGF value was different between gestational hypertension group and the control group (P ＜ 0.01).The sensitivity and specificity of serum sFlt-1,PlGF and sFlt-1/PlGF ratio at 24-28 weeks of gestation to predict preeclampsia were 93％ and 99％ for sFlt-1 (cut off value 2 500 μg/L),92％ and 77％ for PlGF(cut off value 270 μg/L),89％ and 99％ for sFlt-1/PlGF ratio(cut off value 11).Conclusion The value of sFlt-1,PlGF and their ratio at 24-28 weeks of gestation was significantly changed before clinical onset of preeclampsia.Use these serum indicators to predict preeclampsia will hopefully provide objective evidence for the management of patients who will develop preeclampsia later.