OBJECTIVE
To improve the efficiency of pre-eclampsia (PE) prediction by developing percentile values of pre-eclampsia markers for different gestational ages with 1 week interval.
MATERIAL AND METHODS
In the course of the work, a screening examination of pregnant women living in the Moscow region was carried out by the method of continuous sampling. The concentration of proteins in serum, placental growth factor (PlGF), unfolded fms-like tyrosine kinase-1 (sFlt-1), which are markers of PE, was determined. We examined 750 pregnant women who were observed and delivered in the institutions of the Moscow region. All pregnant women were divided into 3 groups: Group 1 included 33 patients with moderate PE; Group 2 included 22 patients with severe PE; Group 3 (control group) included 695 patients without PE. All pregnant women were examined in accordance with the order of the Ministry of Health of Russia from 20.10.20 №1130n «On Approval of the Order of medical care in the profile of «obstetrics and gynecology». Determination of sFlt-1, PlGF concentrations and their ratio (sFlt-1/PlGF) was performed in the blood serum of pregnant women using electrochemiluminescent diagnostic tests Elecsys sFlt-1 and Elecsys PlGF on automatic analyzers Cobas e411 with subsequent calculation of sFlt-1/PlGF ratio for each serum sample. The obtained data were processed using original programs (logistic symptoms based on three-digit logic and non-numerical statistics, using mathematical approximation of median and quartile boundaries for each PE marker). In case of non-normal sample distribution the results of descriptive statistics were presented in the form of median and quartiles, and to determine statistically significant differences between groups we used the nonparametric Mann—Whitney rank test. Differences were considered reliable at p<0.05.
RESULTS
The percentile values of PlGF, sFlt-1 concentration and their ratio sFlt-1/PlGF for different gestational periods in the absence of PE were determined. Diagnostic and prognostic criteria for these markers and their ratios for moderate and severe PE at different gestational periods have been developed. The high efficiency of using these markers of PE in the II trimester for predicting early PE was shown. The sFlt-1/PlGF ratio is the most significant for predicting PE after the 28th week of pregnancy.
CONCLUSION
The use of the developed tables of percentile values of PlGF concentration, sFlt-1 and their ratio allow predicting PE at different dates starting from 14 weeks of pregnancy. The imbalance of PlGF or sFlt-1 — both abnormally high and abnormally low concentrations of marker proteins (below the 25th and above the 75th percentile) are of great importance in predicting PE and identifying the risk of its development, as well as optimizing the tactics of pregnancy management. The previously proposed rule of prognostication of high risk of PE development allows to predict with high accuracy the development of PE, including its severe forms.
