Biomarcadores para el manejo de la eclampsia en embarazadas
Biomarkers for the management of pre-eclampsia in pregnant women.
Petla LT, Chikkala R, Ratnakar K S, Kodati V, Sritharan V.
Indian J Med Res [serial online] 2013 [cited 2013 Aug 6];138:60-7.
Abstract
Pre-eclampsia (PE) is a pregnancy related disorder characterized by hypertension and proteinuria noticeable after 20 wk of gestation. It is a leading cause of maternal and foetal mortality and morbidity worldwide. The aetiology of the disease is unknown, but recent studies have revealed that this disorder appears to originate in placenta and is characterized by widespread maternal endothelial dysfunction. Till date, delivery of placenta is the only cure for the disease. So, there is a need for the identification of highly specific and sensitive biochemical markers that would allow early identification of patients at risk and thus help in providing proper prenatal care. Several promising biomarkers have been proposed, alone or in combination, that may help in predicting women who are likely to develop PE. Maternal serum concentrations of these biomarkers either increase or decrease in PE during gestation. This review focuses on the various biomarkers available and their utility in predicting pre-eclampsia.
Keywords: Angiogenic factors - biomarkers - NGAL - pre-eclampsia - placenta - proteinuria
http://www.ijmr.org.in/text.asp?2013/138/1/60/116198
http://www.ijmr.org.in/temp/IndianJMedRes138160-3442067_093340.pdf
Concentraciones plasmáticas maternas de factores angiogénicos/antiangiogénicos son de valor pronóstico en los pacientes en el áera de triage con sospechas de preeclampsia
Maternal plasma concentrations of angiogenic/anti-angiogenic factors are of prognostic value in patients presenting to the obstetrical triage area with the suspicion of preeclampsia.
Chaiworapongsa T, Romero R, Savasan ZA, Kusanovic JP, Ogge G, Soto E, Dong Z, Tarca A, Gaurav B, Hassan SS.
Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, USA. tchaiwor@med.wayne.edu
J Matern Fetal Neonatal Med. 2011 Oct;24(10):1187-207. doi: 10.3109/14767058.2011.589932. Epub 2011 Aug 9.
Abstract
OBJECTIVE: To determine whether maternal plasma concentrations of placental growth factor (PlGF), soluble endoglin (sEng), soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) and -2 could identify patients at risk for developing preeclampsia (PE) requiring preterm delivery.STUDY DESIGN: Patients presenting with the diagnosis "rule out PE" to the obstetrical triage area of our hospital at <37 weeks of gestation (n = 87) were included in this study. Delivery outcomes were used to classify patients into four groups: I) patients without PE or those with gestational hypertension (GHTN) or chronic hypertension (CHTN) who subsequently developed PE at term (n = 19); II): mild PE who delivered at term (n = 15); III): mild disease (mild PE, GHTN, CHTN) who subsequently developed severe PE requiring preterm delivery (n = 26); and IV): diagnosis of severe PE (n = 27). Plasma concentrations of PlGF, sEng, sVEGFR-1 and -2 were determined at the time of presentation by ELISA. Reference ranges for analytes were constructed by quantile regression in our laboratory (n = 180; 1046 samples). Comparisons among groups were performed using multiples of the median (MoM) and parametric statistics after log transformation. Receiver operating characteristic curves, logistic regression and survival analysis were employed for analysis. RESULTS: The mean MoM plasma concentration of PlGF/sVEGFR-1, PlGF/sEng, PlGF, sVEGFR-1 and -2, and sEng in Group III was significantly different from Group II (all p < 0.05). A plasma concentration of PlGF/sVEGFR-1 ≤ 0.05 MoM or PlGF/sEng ≤0.07 MoM had the highest likelihood ratio of a positive test (8.3, 95% CI 2.8-25 and 8.6, 95% CI 2.9-25, respectively), while that of PlGF ≤0.396 MoM had the lowest likelihood ratio of a negative test (0.08, 95% CI 0.03-0.25). The association between low plasma concentrations of PlGF/sVEGFR-1 (≤0.05 MoM) as well as that of PlGF/sEng (≤0.07 MoM) and the development of severe PE remained significant after adjusting for gestational age at presentation, average systolic and diastolic blood pressure, and a history of chronic hypertension [adjusted odds ratio (OR) = 27 (95% CI 6.4-109) and adjusted OR 30 (95% CI 6.9-126), respectively]. Among patients who presented <34 weeks gestation (n = 59), a plasma concentration of PlGF/sVEGFR-1 < 0.033 MoM identified patients who delivered within 2 weeks because of PE with a sensitivity of 93% (25/27) and a specificity of 78% (25/32). This cut-off was associated with a shorter interval-to-delivery due to PE [hazard ratio = 6 (95% CI 2.5-14.6)]. CONCLUSIONS: Plasma concentrations of angiogenic/anti-angiogenic factors are of prognostic value in the obstetrical triage area. These observations support the value of these biomarkers in the clinical setting for the identification of the patient at risk for disease progression requiring preterm delivery.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384532/pdf/nihms379361.pdf
http://informahealthcare.com/doi/pdf/10.3109/14767058.2011.589932
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
No hay comentarios:
Publicar un comentario