臨床婦人科産科78巻3号

2024年04月発行

今月の臨床 妊娠高血圧症候群―予知・治療・予後の新知見から急変時の対応まで 発症予知・周産期予後の新知見

sFlt-1/PlGFを用いた妊娠高血圧症候群の周産期予後の予測

著者： 田中博明¹ 田中佳世¹

所属機関： ¹三重大学医学部産科婦人科学教室

ページ範囲：P.274 - P.279

●sFlt-1/PlGF比は，妊娠20〜36週の間で，妊娠高血圧腎症（PE）の発症が切迫しているリスクを有している場合に保険適用があり，測定が可能である．

●sFlt-1/PlGF比が38より高い場合はPEの発症が切迫している状況であると考え，intensiveな管理に切り替える．

●sFlt-1/PlGF比が85以上（34週以降は100以上）の場合は，すでにPEを発症し，分娩が切迫している状況であると判断する．

参考文献

1）Rana S, et al : Angiogenic factors and the risk of adverse outcomes in women with suspected preeclampsia. Circulation 125 : 911-919, 2012

2）Zeisler H, et al : Predictive value of the sFlt-1 : PlGF ratio in women with suspected preeclampsia. N Engl J Med 374 : 13-22, 2016

3）Bian X, et al : Short-term prediction of adverse outcomes using the sFlt-1（soluble fms-like tyrosine kinase 1）/PlGF（placental growth factor）ratio in Asian women with suspected preeclampsia. Hypertension 74 : 164-172, 2019

4）Dragan I, et al : Screening for pre-eclampsia using sFlt-1/PlGF ratio cut-off of 38 at 30-37 weeks' gestation. Ultrasound Obstet Gynecol 49 : 73-77, 2017

5）Soundararajan R, et al : Real life outpatient biomarker use in management of hypertensive pregnancies in third trimester in a low resource SeTting : ROBUST study. Pregnancy Hypertens 23 : 97-103, 2021

6）Kim MY, et al : Angiogenic factor imbalance early in pregnancy predicts adverse outcomes in patients with lupus and antiphospholipid antibodies : results of the PROMISSE study. Am J Obstet Gynecol 214 : 108.e1-108.e14, 2016

7）Arenas GA, et al : Use of the angiogenic biomarker profile to risk stratify patients with fetal growth restriction. Am J Obstet Gynecol MFM 3 : 100394, 2021

8）Brown MA, et al : International Society for the Study of Hypertension in Pregnancy（ISSHP） : Hypertensive disorders of pregnancy : ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension 72 : 24-43, 2018

9）Verlohren S, et al : New gestational phase-specific cutoff values for the use of the soluble fms-like tyrosine kinase-1/placental growth factor ratio as a diagnostic test for preeclampsia. Hypertension 63 : 346-352, 2014

10）Verlohren S, et al : The sFlt-1/PlGF ratio in different types of hypertensive pregnancy disorders and its prognostic potential in preeclamptic patients. Am J Obstet Gynecol 206 : 58.e1-58.e8, 2012

11）Takakura S, et al : The role of periodic measurement of sFlt-1 and PlGF in predicting the remaining pregnancy duration in hypertensive disorders of pregnancy. Pregnancy Hypertens 34 : 104-109, 2023

12）Ohkuchi A, et al : Expert consensus : indication criteria and screening strategy for preeclampsia using the serum sFlt-1/PlGF ratio at 18-36 weeks of gestation in women at imminent/basal risk of preeclampsia under insurance coverage. Hypertens Res Pregnancy 8 : 51-56, 2020

13）Verlohren S, et al : The diagnostic value of angiogenic and antiangiogenic factors in differential diagnosis of preeclampsia. Am J Obstet Gynecol 226 : S1048-S1058, 2022