Einflussfaktoren auf die placental growth factor (PlGF) und soluble fms-like tyrosine kinase-1 (sFlt-1) Konzentration im Rahmen des Erst-Trimester-Screenings

Zusammenfassung

Einleitung: Bei einer manifesten Präeklampsie sind die Angiogenesefaktoren soluble fms-like tyrosine kinase-1 (sFlt-1) erhöht und placental growth factor (PlGF) erniedrigt. Dies kann bereits im ersten Trimenon für PLGF signifikant sein.

Material und Methodik: Es liegt eine retrospektive Studie mit 161 Schwangeren aus dem Erst-Trimester-Screening (ETS)vor, bei denen ergänzend sFlt-1 und PlGF mit dem Roche Elecsys^® aus mütterlichem Serum gemessen wurden.

Ergebnisse: Für sFlt-1 ergab sich ein Mittelwert in Höhe von 1 247,11±545,84 pg/ml und für PlGF von 47,00±22,62 pg/ml. Sowohl zwischen sFlt-1 und PAPP-A MoM (r_S=0,681, p<0,001) als auch zwischen PlGF und PAPP-A MoM (r_S=0,465, p<0,001) besteht ein positiv gerichteter Zusammenhang. sFlt-1 korreliert negativ mit dem mütterlichen BMI zum Zeitpunkt des ETS (r_S=−0,225, p=0,005) und ist bei Übergewichtigen gegenüber Normalgewichtigen signifikant erniedrigt (p=0,003). Zwischen PlGF und der Scheitel-Steiß-Länge besteht eine positive Korrelation (r_S=0,27, p<0,001), ein inverser Zusammenhang liegt zwischen PlGF und dem jeweils niedrigeren Pulsatility index der Aa. uterinae vor (r_S=−0,235; p=0,012). Bei Patientinnen mit einem präexistenten Diabetes mellitus sind sFlt-1 und PlGF (p<0,05) signifikant erniedrigt. Raucherinnen zeigen signifikant erhöhte PlGF-Spiegel (p<0,001).

Schlussfolgerung: sFlt-1 und PlGF unterliegen während des ersten Trimenon diversen Einflussfaktoren, die bei der Interpretation der Messwerte Berücksichtigung finden müssen. Zur Validierung der vorliegenden Erkenntnisse sind neben vergangenen Studien weitere prospektive Studien erforderlich. Ziel sollte die Etablierung von MoM-Werten für sFlt-1 und PlGF sein, um die Angiogenesefaktoren als objektivierte, aussagekräftige Screeningparameter verwenden zu können.

Abstract

Introduction: The angiogenic factors soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are significantly altered in preeclampsia with elevated sFlt-1 levels and low PlGF in the continuation of pregnancies. Furthermore, patients with preeclampsia reveal significantly low PlGF levels in the first trimester.

Material and Method: We performed a retrospective study including 161 patients during the first trimester screening between 11+0 and 13+6 weeks of gestation. In addition, we analyzed sFlt-1 und PlGF in maternal serum with a Roche Elecsys^® System.

Results: The mean values for sFlt-1 were 1 247,11±545,84 pg/ml and 47,00±22,62 pg/ml for PlGF. There is a positive correlation between sFlt-1 and PAPP-A MoM (r_S=0,681, p<0,001), and PlGF and PAPP-A MoM (r_S=0,465, p<0,001), respectively. There was a negative correlation between sFlt-1 and maternal body mass index (r_S=−0,225, p=0,005). Overweight patients had significantly lower sFlt-1 values than patients with normal weight (p=0,003). PlGF and the crown-rump-length of the fetus showed a positive correlation (r_S=0,27, p<0,001), whereas PlGF and the Pulsatility Index of the uterine arteries were negative correlated (r_S=−0,235; p=0,012). Patients with a preexistent diabetes mellitus had significantly low sFlt-1 und PlGF (p<0,05) values. Smokers had significantly elevated PlGF-values (p<0,001).

Conclusion: sFlt-1 and PlGF are influenced by various factors during the first trimester of pregnancy which can be relevant for correct interpretation. Further prospective studies may be necessary to validate our results. The aim should be to establish sFlt-1 and PlGF MoM values to allow for integration into a screening for preeclampsia in the first trimester.

Schlüsselwörter

PLGF - sFlt-1 - Erst-Trimester-Screening - Präeklampsie

Key words

PlGF - sFlt -1 - first trimester screening - preeclampsia

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