目的：比较根据病史的危险因素筛查先兆子痫（PE）的表现，根据NICE和ACOG的建议，采用胎儿医学基金会(FMF)提出的方法，它使用贝叶斯定理将母性因素的先验风险结合起来，由多变量逻辑模型得出，生物物理和生化测量的各种组合的结果。
方法：这是一项前瞻性多中心研究，对8775例妊娠11-13周的单胎妊娠进行PE筛查。先前公开的FMF算法用于计算每个个体中的患者特异性PE风险。评估PE<32周、<37周和≥37周的检出率（DR）和假阳性率（FPR），并与应用NICE指南和ACOG建议的结果进行比较。根据NICE,所有高危妊娠患者均应服用低剂量阿司匹林.根据ACOG，阿司匹林的使用应保留给既往有至少两次妊娠或需要分娩<34周的PE病史的女性。
结果：在研究人群中，239例（2.7%）发生PE，其中17人(0.2%)，59（0.7％）和180（2.1％）发展PE<32，<37和≥37周，分别。使用基于母体因素组合的FMF算法进行筛查，平均动脉压(MAP),子宫动脉搏动指数（UtA-PI）和血清胎盘生长因子（PlGF）检测到PE<32周的100％（95％CI，80-100％），75％（95％CI，62-85％）的PE<37周和43％（95％CI，35-50％）的PE≥37周，在10.0%的FPR。使用NICE指南的筛查检测到41％（95％CI，18-67％）的PE<32周，39％（95％CI，27-53％）的PE<37周和34％（95％CI，27-41％）的PE≥37周，在10.2%FPR。使用ACOG推荐的筛查检测到94％（95％CI，71-100％）的PE<32周，90％（95％CI，79-96％）的PE<37周和89％（95％CI，84-94％）的PE≥37周，在64.2%FPR。根据ACOG建议使用阿司匹林的筛查检测到6％（95％CI，1-27％）的PE<32周，5％（95％CI，2-14％）的PE<37周和2％（95％CI，0.3-5％）的PE≥37周，在0.2%FPR。
结论：通过FMF算法使用母体因素的组合在妊娠11-13周时进行PE筛查，MAP,UtA-PI和PlGF，远远优于NICE和ACOG推荐的方法。版权所有©2017ISUOG。由JohnWiley&SonsLtd.发布.
OBJECTIVE: To compare the performance of screening for pre-eclampsia (PE) based on risk factors from medical history, as recommended by NICE and ACOG, with the method proposed by The Fetal Medicine Foundation (FMF), which uses Bayes\' theorem to combine the a-priori risk from maternal factors, derived by a multivariable logistic model, with the results of various combinations of biophysical and biochemical measurements.
METHODS: This was a prospective multicenter study of screening for PE in 8775 singleton pregnancies at 11-13 weeks\' gestation. A previously published FMF algorithm was used for the calculation of patient-specific risk of PE in each individual. The detection rates (DRs) and false-positive rates (FPRs) for delivery with PE < 32, < 37 and ≥ 37 weeks were estimated and compared with those derived from application of NICE
guidelines and ACOG recommendations. According to NICE, all high-risk pregnancies should be offered low-dose aspirin. According to ACOG, use of aspirin should be reserved for women with a history of PE in at least two previous pregnancies or PE requiring delivery < 34 weeks\' gestation.
RESULTS: In the study population, 239 (2.7%) cases developed PE, of which 17 (0.2%), 59 (0.7%) and 180 (2.1%) developed PE < 32, < 37 and ≥ 37 weeks, respectively. Screening with use of the FMF algorithm based on a combination of maternal factors, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and serum placental growth factor (PlGF) detected 100% (95% CI, 80-100%) of PE < 32 weeks, 75% (95% CI, 62-85%) of PE < 37 weeks and 43% (95% CI, 35-50%) of PE ≥ 37 weeks, at a 10.0% FPR. Screening with use of NICE
guidelines detected 41% (95% CI, 18-67%) of PE < 32 weeks, 39% (95% CI, 27-53%) of PE < 37 weeks and 34% (95% CI, 27-41%) of PE ≥ 37 weeks, at 10.2% FPR. Screening with use of ACOG recommendations detected 94% (95% CI, 71-100%) of PE < 32 weeks, 90% (95% CI, 79-96%) of PE < 37 weeks and 89% (95% CI, 84-94%) of PE ≥ 37 weeks, at 64.2% FPR. Screening based on the ACOG recommendations for use of aspirin detected 6% (95% CI, 1-27%) of PE < 32 weeks, 5% (95% CI, 2-14%) of PE < 37 weeks and 2% (95% CI, 0.3-5%) of PE ≥ 37 weeks, at 0.2% FPR.
CONCLUSIONS: Performance of screening for PE at 11-13 weeks\' gestation by the FMF algorithm using a combination of maternal factors, MAP, UtA-PI and PlGF, is by far superior to the methods recommended by NICE and ACOG. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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