The Use Of SFlt-1and PlGF In Discriminating Preeclampsia And Predicting The Disease In Second-trimester

Objectives:1. To determine the serum levels of soluble Fms-like tyrosine kinase1(sFlt-1) and placental growth factor (PIGF) in local normal-tensive pregnant women in different gestational weeks.2. To determine the serum ieveis of sFit-1and PiGF in preeclampsia complicated pregnancies and to evaluate the diagnostic value with the optimal Cut Off values.3. To estimate the second-trimester predictive value of sFlt-1and PIGF in discriminating preeclampsia.Methods:This study involves297singleton pregnancies in following groups:1. normal-tensive pregnant women from10gestational weeks to term delivery (n=235); patients with preeclampsia complicated pregnancy (n=20), gestational hypertension (n=4) and patients who develop preeclampsia several weeks after sampling (n=2);2.36samples were taken between15to18gestational weeks from patients who destined to develop preeclampsia (n=24) and gestational hypertension (n=12). Serum sFlt-1and PIGF are measured by electro chemiluminescence immunoassay (ECLIA).Results:1. In normal-tensive pregnancies serum sFlt-1maintains stable in first and second trimester but is significantly elevated in third trimester especially after37weeks; PIGF concentration increase gradually in first and second trimester and reach peak about30gestational weeks then decrease.2. Compared to controls, patients with preeclampsia have significant higher serum sFlt-1and lower PIGF,p<0.001; using73pg/ml as the Cut Off value of PIGF, the sensitivity and specificity are80%and98.7%, respectively; using47.70as the Cut Off value of sFlt-1/PIGF, the sensitivity and specificity are80.0%and98.1%, respectively.3. In second trimester, patients destined to develop preeclampsia and gestational hypertension have significantly lower serum PIGF levels than controls, p<0.05, but it has poor predictive value when used alone with sensitivity and specificity of72.2%and70.2%, respectively.4. Serum levels of sFlt-1and PIGF have changed3-5weeks prior to clinical onset of the disease.5. In control group, the subgroup with proteinuria has a significantly higher serum level of sFlt-1than completely normal subgroup. Conclusions:1. PIGF and sFlt-1/PIGF can be used to discriminate preeclampsia.2. Patients destined to develop preeclampsia have significantly lower serum PIGF in second trimester(15-18gestational weeks) compared to controls, but it has poor predictive value.3. Single proteinuria in pregnancy is related to higher serum sFlt-1level.