Abstract：
OBJECTIVE: To assess the utility of placental growth factor (PlGF) levels and the soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio to predict preterm birth (PTB) for infants with fetal growth restriction (FGR) and those appropriate for gestational age (AGA).
METHODS: Prospective, observational cohort study.
METHODS: Tertiary maternity hospital in Australia.
METHODS: There were 320 singleton pregnancies: 141 (44.1%) AGA, 83 (25.9%) early FGR (<32+0 weeks) and 109 (30.0%) late FGR (≥32+0 weeks).
METHODS: Maternal serum PlGF and sFlt-1/PlGF ratio were measured at 4-weekly intervals from recruitment to delivery. Low maternal PlGF levels and elevated sFlt-1/PlGF ratio were defined as <100 ng/L and >5.78 if <28 weeks and >38 if ≥28 weeks respectively. Cox proportional hazards models were used. The analysis period was defined as the time from the first measurement of PlGF and sFlt-1/PlGF ratio to the time of birth or censoring.
METHODS: The primary study outcome was overall PTB. The relative risks (RR) of birth within 1, 2 and 3 weeks and for medically indicated and spontaneous PTB were also ascertained.
RESULTS: The early FGR cohort had lower median PlGF levels (54 versus 229 ng/L, p < 0.001) and higher median sFlt-1 levels (2774 ng/L versus 2096 ng/L, p < 0.001) and sFlt-1/PlGF ratio higher (35 versus 10, p < 0.001). Both PlGF <100 ng/L and elevated sFlt-1/PlGF ratio were strongly predictive for PTB as well as PTB within 1, 2 and 3 weeks of diagnosis. For both FGR and AGA groups, PlGF <100 ng/L or raised sFlt-1/PlGF ratio were strongly associated with increased risk for medically indicated PTB. The highest RR was seen in the FGR cohort when PlGF was <100 ng/L (RR 35.20, 95% CI 11.48-175.46).
CONCLUSIONS: Low maternal PlGF levels and elevated sFlt-1/PlGF ratio are potentially useful to predict PTB in both FGR and AGA pregnancies.
METHODS: Prospective, observational cohort study.
METHODS: Tertiary maternity hospital in Australia.
METHODS: There were 320 singleton pregnancies: 141 (44.1%) AGA, 83 (25.9%) early FGR (<32+0 weeks) and 109 (30.0%) late FGR (≥32+0 weeks).
METHODS: Maternal serum PlGF and sFlt-1/PlGF ratio were measured at 4-weekly intervals from recruitment to delivery. Low maternal PlGF levels and elevated sFlt-1/PlGF ratio were defined as <100 ng/L and >5.78 if <28 weeks and >38 if ≥28 weeks respectively. Cox proportional hazards models were used. The analysis period was defined as the time from the first measurement of PlGF and sFlt-1/PlGF ratio to the time of birth or censoring.
METHODS: The primary study outcome was overall PTB. The relative risks (RR) of birth within 1, 2 and 3 weeks and for medically indicated and spontaneous PTB were also ascertained.
RESULTS: The early FGR cohort had lower median PlGF levels (54 versus 229 ng/L, p < 0.001) and higher median sFlt-1 levels (2774 ng/L versus 2096 ng/L, p < 0.001) and sFlt-1/PlGF ratio higher (35 versus 10, p < 0.001). Both PlGF <100 ng/L and elevated sFlt-1/PlGF ratio were strongly predictive for PTB as well as PTB within 1, 2 and 3 weeks of diagnosis. For both FGR and AGA groups, PlGF <100 ng/L or raised sFlt-1/PlGF ratio were strongly associated with increased risk for medically indicated PTB. The highest RR was seen in the FGR cohort when PlGF was <100 ng/L (RR 35.20, 95% CI 11.48-175.46).
CONCLUSIONS: Low maternal PlGF levels and elevated sFlt-1/PlGF ratio are potentially useful to predict PTB in both FGR and AGA pregnancies.
摘要：
目的：评估胎盘生长因子（PlGF）水平和可溶性fms样酪氨酸激酶-1/胎盘生长因子（sFlt-1/PlGF）比值在预测早产（PTB）中的实用性胎儿生长受限（FGR）和适合胎龄（AGA）的婴儿。
方法：前瞻性，观察性队列研究。
方法：澳大利亚三级妇产医院。
方法：有320例单胎妊娠：141（44.1％）AGA，83（25.9％）早期FGR（<32+0周）和109（30.0％）晚期FGR（≥32+0周）。
方法：从招募到分娩，每隔4周测量母亲血清PlGF和sFlt-1/PlGF比值。低母体PlGF水平和升高的sFlt-1/PlGF比率分别定义为如果<28周则<100ng/L和>5.78,如果≥28周则>38。使用Cox比例风险模型。分析期定义为从第一次测量PlGF和sFlt-1/PlGF比率到出生或审查时间的时间。
方法：主要研究结果是总体PTB。还确定了1、2和3周内出生的相对风险（RR）以及医学指示和自发性PTB。
结果：早期FGR队列的PlGF水平中位数较低（54比229ng/L，p<0.001）和更高的中位数sFlt-1水平（2774ng/L对2096ng/L，p<0.001）和sFlt-1/PlGF比率更高（35对10，p<0.001）。PlGF<100ng/L和升高的sFlt-1/PlGF比率在诊断的1、2和3周内对PTB以及PTB均具有强烈的预测作用。对于FGR和AGA组，PlGF<100ng/L或升高的sFlt-1/PlGF比率与医学上指示的PTB的风险增加密切相关。当PlGF<100ng/L时，FGR队列中的RR最高（RR35.20，95％CI11.48-175.46）。
结论：低母体PlGF水平和升高的sFlt-1/PlGF比值可能有助于预测FGR和AGA妊娠中的PTB。
方法：前瞻性，观察性队列研究。
方法：澳大利亚三级妇产医院。
方法：有320例单胎妊娠：141（44.1％）AGA，83（25.9％）早期FGR（<32+0周）和109（30.0％）晚期FGR（≥32+0周）。
方法：从招募到分娩，每隔4周测量母亲血清PlGF和sFlt-1/PlGF比值。低母体PlGF水平和升高的sFlt-1/PlGF比率分别定义为如果<28周则<100ng/L和>5.78,如果≥28周则>38。使用Cox比例风险模型。分析期定义为从第一次测量PlGF和sFlt-1/PlGF比率到出生或审查时间的时间。
方法：主要研究结果是总体PTB。还确定了1、2和3周内出生的相对风险（RR）以及医学指示和自发性PTB。
结果：早期FGR队列的PlGF水平中位数较低（54比229ng/L，p<0.001）和更高的中位数sFlt-1水平（2774ng/L对2096ng/L，p<0.001）和sFlt-1/PlGF比率更高（35对10，p<0.001）。PlGF<100ng/L和升高的sFlt-1/PlGF比率在诊断的1、2和3周内对PTB以及PTB均具有强烈的预测作用。对于FGR和AGA组，PlGF<100ng/L或升高的sFlt-1/PlGF比率与医学上指示的PTB的风险增加密切相关。当PlGF<100ng/L时，FGR队列中的RR最高（RR35.20，95％CI11.48-175.46）。
结论：低母体PlGF水平和升高的sFlt-1/PlGF比值可能有助于预测FGR和AGA妊娠中的PTB。
