母体循环血管生成生物标志物用于预测无先兆子痫的胎儿生长受限及小于胎龄儿分娩。
完整摘要 · 中文译文
母体循环中的血管生成因子是子痫前期中已确立的生物标志物，但在不伴子痫前期的胎儿生长受损中，其早期水平仍不清楚。我们对观察性研究的数据进行了定量汇总，这些研究测量了在29周前且临床识别出生长受损之前的单胎妊娠（不伴子痫前期）母体血清胎盘生长因子（PlGF）、可溶性fms样酪氨酸激酶-1（sFlt-1）或其比值，随后将妊娠分类为胎儿生长受限（FGR）、小于胎龄儿（SGA）或未受影响。检索了PubMed、Embase和Cochrane图书馆，截止至2026年4月；共纳入22项研究。在随机效应荟萃分析中，受影响妊娠中的PlGF较低（标准化均数差[SMD] -0.38；95% CI -0.63至-0.13；I2 = 92.0%；19项研究），而sFlt-1无差异（SMD 0.03；95% CI -0.27至0.34；I2 = 79.5%；12项研究），且主要分析中的比值较高（SMD 0.39；95% CI 0.08至0.70；I2 = 80.0%；七项研究）。这一模式提示比值信号主要受较低的PlGF影响。对五项PlGF准确性研究的双变量分析得出汇总敏感性为0.29，特异性为0.86。尽管存在显著的异质性，但在随后被分类为不伴子痫前期的FGR/SGA妊娠中，PlGF降低是最一致的早期血管生成特征。其低敏感性不支持将其作为独立筛查试验使用，但这些发现支持在多种标志物联合预测模型中进一步评估PlGF的价值。
完整摘要 · 英文原文
Maternal circulating angiogenic factors are established biomarkers in preeclampsia, but their early profiles in fetal growth impairment without preeclampsia remain unclear. We quantitatively synthesized data from observational studies measuring maternal serum placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), or their ratio before 29 weeks and before clinical recognition of growth impairment in singleton pregnancies without preeclampsia, subsequently classified as fetal growth restriction (FGR), small for gestational age (SGA), or unaffected. PubMed, Embase, and the Cochrane Library were searched through April 2026; 22 studies were included. In random-effects meta-analysis, PlGF was lower in affected pregnancies (standardized mean difference [SMD] -0.38; 95% CI -0.63 to -0.13; I2 = 92.0%; 19 studies), whereas sFlt-1 did not differ (SMD 0.03; 95% CI -0.27 to 0.34; I2 = 79.5%; 12 studies) and the ratio was higher in the primary analysis (SMD 0.39; 95% CI 0.08 to 0.70; I2 = 80.0%; seven studies). This pattern suggests that the ratio signal was influenced largely by lower PlGF. Bivariate analysis of five PlGF accuracy studies yielded a summary sensitivity of 0.29 and specificity of 0.86. Despite substantial heterogeneity, reduced PlGF was the most consistent early angiogenic feature in pregnancies subsequently classified as FGR/SGA without preeclampsia. Its low sensitivity does not support its use as a stand-alone screening test, but these findings warrant further evaluation of PlGF within multimarker prediction models.