Несмотря на то что преэклампсия считается лидирующей причиной перинатальной заболеваемости и смертности, ее патофизиология остается неизвестной. Ранний прогноз преэклампсии позволит вовремя начать превентивную терапию. Сочетание анамнеза, биофизических и биохимических маркеров предпочтительнее других тестов в раннем прогнозировании развития преэклампсии. В данной статье проанализированы недавние исследования наиболее важных стратегий по прогнозу преэклампсии, включая материнские факторы риска и биомаркеры. Ключевые слова: преэклампсия, беременность, биомаркеры, прогноз.
________________________________________________
Despite of preeclampsia is a leading cause of perinatal morbidity and mortality, the pathophysiology of preeclampsia remains unknown. Early prediction of preeclampsia would allow for timely initiation of preventive therapy. A combination of anamnesis, biophysical and biochemical markers are superior to other tests for early prediction of the development of preeclampsia. This article reviews the current research of the most important strategies for prediction of preeclampsia, including the use of maternal risk factors and biomarkers. Key words: preeclampsia, pregnancy, biomarker, prognosis.
1. Hladunewich M, Karumanchi SA, Lafayette R. Pathophysiology of the clinical manifestations of preeclampsia. Clin J Am SocNephrol 2007; 2: 543–9.
2. Ghulmiyyah, L, Sibai, B. Maternal mortality from preeclampsia/eclampsia. Semin Perinatol 2012; 36: 56–9.
3. Ananth CV, Keyes KM, Wapner RJ. Preeclampsia rates in the United States, 1980–2010: age-period-cohort analysis. BMJ 2013; 347: f6564.
4. Yliniemi A, Nurkkala M-M, Kopman S, Korpimaki T et al. First Trimester Placental Retinol-Binding Protein 4 (RBP4) and Pregnancy-Associated Placental Protein A (PAPP-A) in the Prediction of Early-Onset Severe Preeclampsia. Metabol clinic experimental 2015; 64: 521–26.
5. Somani S, Choudhary V, Babu P, Vijayalaxmi A. To determine association of lipid profile, serum uric acid and body mass index as a marker for preeclampsia. Int J Cur Res Rev 2015; 7 (11): 53–7.
6. North RA, McCowan LM, Dekker GA et al. Clinical risk prediction for pre-eclampsia in nulliparous women: Development of model in international prospective cohort. BMJ 2011; 342. doi:10.1136/ bmj.d1875.
7. Wu P, van den Berg C, Alfirevic Z, O’Brien S et al. Early Pregnancy Biomarkers in Pre-Eclampsia: A Systematic Review and Meta-Analysis. Int J Mol Sci 2015; 16: 23035–56.
8. Thilaganathan B, Wormald B, Zanardini C et al. Early-pregnancy multiple serum markers and second-trimester uterine artery Doppler in predicting preeclampsia. Obstet Gynecol 2010; 115: 1233–8.
9. Roberge S, Giguere Y, Villa P et al. Early administration of low-dose aspirin for the prevention of severe and mild preeclampsia: a systematic review and meta-analysis. Am J Perinatol 2012; 29: 551–6 [PubMed: 22495898].
10. Akolekar R, Syngelaki A, Sarquis R et al. Prediction of early, intermediate and late preeclampsia from maternal factors, biophysical and biochemical markers at 11–13 weeks. Prenat Diagn 2011; 31: 66–74.
11. Koopmans CM, Bijlenga D, Groen H et al. Induction of labour vs. expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): A multicentre, open-label randomised controlled trial. Lancet 2009; 374: 979–88.
12. Yu CK, Khouri O, Onwudiwe N et al. Medicine Foundation Second-Trimester Screening Group. Prediction of preeclampsia by uterine artery Doppler imaging: Relationship to gestational age at delivery and small-for-gestational age. Ultrasound Obstet Gynecol 2008; 31: 310–3.
13. Park HJ, Shim SS, Cha DH. Combined Screening for Early Detection of Pre-Eclampsia. Int J Mol Sci 2015; 16: 17952–74.
14. Anderson UD, Gram M, Thilaganathan B et al. [97-POS]: Free fetal hemoglobin and hemoglobin-scavenging proteins are predictive first and second trimester biochemical markers for preeclampsia. Pregnancy Hypertens 2015; 5: 53.
15. Small H, Currie G, Delles C. Prostasin, proteases, and preeclampsia. J Hypertens 2016; 34: 193–5.
16. Allen RE, Rogozinska E, Cleverly K et al. Abnormal blood biomarkers in early pregnancy are associated with preeclampsia: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 2014; 182: 194–201. doi: 10.1016/j.ejogrb.2014.09.027 PMID: 25305662.
17. Garcé́s M, Sanchez E, Cardona L, Simanca E et al. Maternal serum meteorin levels and the risk of preeclampsia. PLoS One. doi: 10.1371/journal.pone.0131013.
18. Cuckle HS. Screening for preeclampsia – Lessons from aneuploidy screening. Placent 2011; 32 (Suppl. 1): S42–S48.
19. Redman CWG, Sargent IL. Preeclampsia and the systemic inflammatory response. Semin Nephrol 2004; 24: 565–70.
20. Tangerå̊s L, Austdal M, Skrå̊̊stad R, Salvesen K et al. Distinct First Trimester Cytokine Profiles for Gestational Hypertension and Preeclampsia. Arterioscler Thromb Vasc Biol 2015; 35: 2478–85.
21. Tsiakkas A, Duvdevani N, Wright A et al. Serum placental growth factor in the three trimesters of pregnancy: Effects of maternal characteristics and medical history. Ultrasound Obstet Gynecol 2015; 45: 591–8.
22. Levine RJ, Maynard SE, Qian C et al. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med 2004; 350: 672–83.
23. Lawrence JB, Oxvig C, Overgaard MT et al. The insulin-like growth factor [IGF]- dependent IGF binding protein-4 protease secreted by human fibroblasts is pregnancy-associated plasma protein-A. Proc Natl Acad Sci USA 1999; 96: 3149–53.
24. Bersinger NA, Odegard RA. Second- and third-trimester serum levels of placental proteins in preeclampsia and small-for-gestational age pregnancies. Acta Obstet Gynecol Scand 2004; 83: 37–45.
25. Bersinger NA, Smarason AK, Muttukrishna S et al. Women with pre-eclampsia have increased serum levels of pregnancy-associated plasma protein A (PAPP-A), inhibin-A, activin-A and soluble E-selectin. Hypertens Pregnancy 2003; 22: 45–55.
26. Poon LC, Akolekar R, Lachmann R et al. Hypertensive disorders in pregnancy: Screening by biophysical and biochemical markers at 11–13 weeks. Ultrasound Obstet Gynecol 2010; 35: 662–70.
27. Sibai BM, Koch MA, Freire S et al. Serum inhibin-A and angiogenic factor levels in pregnancies with previous preeclampsia and/or chronic hypertension: Are they useful markers for prediction of subsequent preeclampsia? Am J Obstet Gynecol 2008; 199: 268e1–e9.
28. Shi Z, Xu W, Loechel F et al. ADAM 12, a disintegrinmetalloprotease, interacts with insulin-like growth factor-binding protein-3. J Biol Chem 2000; 275: 18574–80.
29. Loechel F, Fox JW, Murphy G et al. ADAM 12-S cleaves IGFBP-3 and IGFBP-5 and is inhibited by TIMP-3. Biochem Biophys Res Commun 2000; 278: 511–5.
30. Spencer K, Cowans NJ, Stamatopoulou A. ADAM12s in maternal serum as a potential marker of pre-eclampsia. Prenat Diagn 2008; 28: 212–6.
31. Kristensen K, Larsson I, Hansson SR. Increased cystatin C expression in the pre-eclamptic placenta. Mol Hum Reprod 2007; 13: 189–95.
32. Thilaganathan B, Ralph E, Papageorghiou AT et al. Raised maternal serum cystatin C: An early pregnancy marker for preeclampsia. Reprod Sci 2009; 16: 788–93.
33. Metcalfe A, Langlois S, Macfarlane J et al. Prediction of obstetrical risk using maternal serum markers and clinical risk factors. Prenat Diagn 2013; 2: 172–9.
34. Vaisbuch E, Romero R, Mazaki-Tovi S et al. Retinol binding protein 4 – a novel association with early-onset preeclampsia. J Perinat Med 2010; 382: 129–39.
35. Alkharfy KM, Al-Daghri NM, Vanhoutte PM et al. Serum retinol-binding protein 4 as a marker for cardiovascular disease in women. PLoS One 2012; 710: e48612.
36. Shangguan XI, Liu F, Wang H et al. Alterations in serum adipocyte fatty acid binding protein and retinol binding protein-4 in normal pregnancy and preeclampsia. Clin Chim Acta 2009; 4071–2: 58–61.
37. Myatt L, Clifton RG, Roberts JM et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development [NICHD] Maternal-Fetal Medicine Units [MFMU] Network. First-trimester prediction of preeclampsia in nulliparous women at low risk. Obstet Gynecol 2012; 1196: 1234–42.
38. Poon LC, Maiz N, Valencia C et al. First-trimester maternal serum pregnancy-associated plasma protein-A and preeclampsia. Ultrasound Obstet Gynecol 2009; 33: 23–33.
39. Stepan H, Ebert T, Schrey S et al. Preliminary report: serum levels of retinol binding protein 4 in preeclampsia. Metab Clin Exp 2009; 58: 275–7.
40. Nanda S, Nikoletakis G, Markova D et al. Maternal serum retinol-binding protein-4 at 11–13 weeks' gestation in normal and pathological pregnancies. Metabolism 2013; 626: 814–9.
41. Giguere Y, Masse J, Theriault S et al. Screening for pre-eclampsia early in pregnancy: performance of a multivariable model combining clinical characteristics and biochemical markers. BJOG 2015; 122: 402–10.
42. Poon LC, Maiz N, Valencia C et al. First-trimester maternal serum pregnancy-associated plasma protein-A and pre-eclampsia. Ultrasound Obstet Gynecol 2009; 33: 23–33.
43. Powers RW, Roberts JM, Plymire DA et al. Low placental growth factor across pregnancy identifies a subset of women with preterm preeclampsia: type 1 versus type 2 preeclampsia? Hypertension 2012; 60: 239–46.
44. Дубровина С.О., Муцалханова Ю.С., Тикиджиева В.Ю. Поиск ранних прогностических маркеров преэклампсии. Таврический медико-биологич. вестн. 2016; 19 (2): 62–4. / Dubrovina S.O., Mutsalkhanova Iu.S., Tikidzhieva V.Iu. Poisk rannikh prognosticheskikh markerov preeklampsii. Tavricheskii mediko-biologich. vestn. 2016; 19 (2): 62–4. [in Russian]
________________________________________________
1. Hladunewich M, Karumanchi SA, Lafayette R. Pathophysiology of the clinical manifestations of preeclampsia. Clin J Am SocNephrol 2007; 2: 543–9.
2. Ghulmiyyah, L, Sibai, B. Maternal mortality from preeclampsia/eclampsia. Semin Perinatol 2012; 36: 56–9.
3. Ananth CV, Keyes KM, Wapner RJ. Preeclampsia rates in the United States, 1980–2010: age-period-cohort analysis. BMJ 2013; 347: f6564.
4. Yliniemi A, Nurkkala M-M, Kopman S, Korpimaki T et al. First Trimester Placental Retinol-Binding Protein 4 (RBP4) and Pregnancy-Associated Placental Protein A (PAPP-A) in the Prediction of Early-Onset Severe Preeclampsia. Metabol clinic experimental 2015; 64: 521–26.
5. Somani S, Choudhary V, Babu P, Vijayalaxmi A. To determine association of lipid profile, serum uric acid and body mass index as a marker for preeclampsia. Int J Cur Res Rev 2015; 7 (11): 53–7.
6. North RA, McCowan LM, Dekker GA et al. Clinical risk prediction for pre-eclampsia in nulliparous women: Development of model in international prospective cohort. BMJ 2011; 342. doi:10.1136/ bmj.d1875.
7. Wu P, van den Berg C, Alfirevic Z, O’Brien S et al. Early Pregnancy Biomarkers in Pre-Eclampsia: A Systematic Review and Meta-Analysis. Int J Mol Sci 2015; 16: 23035–56.
8. Thilaganathan B, Wormald B, Zanardini C et al. Early-pregnancy multiple serum markers and second-trimester uterine artery Doppler in predicting preeclampsia. Obstet Gynecol 2010; 115: 1233–8.
9. Roberge S, Giguere Y, Villa P et al. Early administration of low-dose aspirin for the prevention of severe and mild preeclampsia: a systematic review and meta-analysis. Am J Perinatol 2012; 29: 551–6 [PubMed: 22495898].
10. Akolekar R, Syngelaki A, Sarquis R et al. Prediction of early, intermediate and late preeclampsia from maternal factors, biophysical and biochemical markers at 11–13 weeks. Prenat Diagn 2011; 31: 66–74.
11. Koopmans CM, Bijlenga D, Groen H et al. Induction of labour vs. expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): A multicentre, open-label randomised controlled trial. Lancet 2009; 374: 979–88.
12. Yu CK, Khouri O, Onwudiwe N et al. Medicine Foundation Second-Trimester Screening Group. Prediction of preeclampsia by uterine artery Doppler imaging: Relationship to gestational age at delivery and small-for-gestational age. Ultrasound Obstet Gynecol 2008; 31: 310–3.
13. Park HJ, Shim SS, Cha DH. Combined Screening for Early Detection of Pre-Eclampsia. Int J Mol Sci 2015; 16: 17952–74.
14. Anderson UD, Gram M, Thilaganathan B et al. [97-POS]: Free fetal hemoglobin and hemoglobin-scavenging proteins are predictive first and second trimester biochemical markers for preeclampsia. Pregnancy Hypertens 2015; 5: 53.
15. Small H, Currie G, Delles C. Prostasin, proteases, and preeclampsia. J Hypertens 2016; 34: 193–5.
16. Allen RE, Rogozinska E, Cleverly K et al. Abnormal blood biomarkers in early pregnancy are associated with preeclampsia: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 2014; 182: 194–201. doi: 10.1016/j.ejogrb.2014.09.027 PMID: 25305662.
17. Garcé́s M, Sanchez E, Cardona L, Simanca E et al. Maternal serum meteorin levels and the risk of preeclampsia. PLoS One. doi: 10.1371/journal.pone.0131013.
18. Cuckle HS. Screening for preeclampsia – Lessons from aneuploidy screening. Placent 2011; 32 (Suppl. 1): S42–S48.
19. Redman CWG, Sargent IL. Preeclampsia and the systemic inflammatory response. Semin Nephrol 2004; 24: 565–70.
20. Tangerå̊s L, Austdal M, Skrå̊̊stad R, Salvesen K et al. Distinct First Trimester Cytokine Profiles for Gestational Hypertension and Preeclampsia. Arterioscler Thromb Vasc Biol 2015; 35: 2478–85.
21. Tsiakkas A, Duvdevani N, Wright A et al. Serum placental growth factor in the three trimesters of pregnancy: Effects of maternal characteristics and medical history. Ultrasound Obstet Gynecol 2015; 45: 591–8.
22. Levine RJ, Maynard SE, Qian C et al. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med 2004; 350: 672–83.
23. Lawrence JB, Oxvig C, Overgaard MT et al. The insulin-like growth factor [IGF]- dependent IGF binding protein-4 protease secreted by human fibroblasts is pregnancy-associated plasma protein-A. Proc Natl Acad Sci USA 1999; 96: 3149–53.
24. Bersinger NA, Odegard RA. Second- and third-trimester serum levels of placental proteins in preeclampsia and small-for-gestational age pregnancies. Acta Obstet Gynecol Scand 2004; 83: 37–45.
25. Bersinger NA, Smarason AK, Muttukrishna S et al. Women with pre-eclampsia have increased serum levels of pregnancy-associated plasma protein A (PAPP-A), inhibin-A, activin-A and soluble E-selectin. Hypertens Pregnancy 2003; 22: 45–55.
26. Poon LC, Akolekar R, Lachmann R et al. Hypertensive disorders in pregnancy: Screening by biophysical and biochemical markers at 11–13 weeks. Ultrasound Obstet Gynecol 2010; 35: 662–70.
27. Sibai BM, Koch MA, Freire S et al. Serum inhibin-A and angiogenic factor levels in pregnancies with previous preeclampsia and/or chronic hypertension: Are they useful markers for prediction of subsequent preeclampsia? Am J Obstet Gynecol 2008; 199: 268e1–e9.
28. Shi Z, Xu W, Loechel F et al. ADAM 12, a disintegrinmetalloprotease, interacts with insulin-like growth factor-binding protein-3. J Biol Chem 2000; 275: 18574–80.
29. Loechel F, Fox JW, Murphy G et al. ADAM 12-S cleaves IGFBP-3 and IGFBP-5 and is inhibited by TIMP-3. Biochem Biophys Res Commun 2000; 278: 511–5.
30. Spencer K, Cowans NJ, Stamatopoulou A. ADAM12s in maternal serum as a potential marker of pre-eclampsia. Prenat Diagn 2008; 28: 212–6.
31. Kristensen K, Larsson I, Hansson SR. Increased cystatin C expression in the pre-eclamptic placenta. Mol Hum Reprod 2007; 13: 189–95.
32. Thilaganathan B, Ralph E, Papageorghiou AT et al. Raised maternal serum cystatin C: An early pregnancy marker for preeclampsia. Reprod Sci 2009; 16: 788–93.
33. Metcalfe A, Langlois S, Macfarlane J et al. Prediction of obstetrical risk using maternal serum markers and clinical risk factors. Prenat Diagn 2013; 2: 172–9.
34. Vaisbuch E, Romero R, Mazaki-Tovi S et al. Retinol binding protein 4 – a novel association with early-onset preeclampsia. J Perinat Med 2010; 382: 129–39.
35. Alkharfy KM, Al-Daghri NM, Vanhoutte PM et al. Serum retinol-binding protein 4 as a marker for cardiovascular disease in women. PLoS One 2012; 710: e48612.
36. Shangguan XI, Liu F, Wang H et al. Alterations in serum adipocyte fatty acid binding protein and retinol binding protein-4 in normal pregnancy and preeclampsia. Clin Chim Acta 2009; 4071–2: 58–61.
37. Myatt L, Clifton RG, Roberts JM et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development [NICHD] Maternal-Fetal Medicine Units [MFMU] Network. First-trimester prediction of preeclampsia in nulliparous women at low risk. Obstet Gynecol 2012; 1196: 1234–42.
38. Poon LC, Maiz N, Valencia C et al. First-trimester maternal serum pregnancy-associated plasma protein-A and preeclampsia. Ultrasound Obstet Gynecol 2009; 33: 23–33.
39. Stepan H, Ebert T, Schrey S et al. Preliminary report: serum levels of retinol binding protein 4 in preeclampsia. Metab Clin Exp 2009; 58: 275–7.
40. Nanda S, Nikoletakis G, Markova D et al. Maternal serum retinol-binding protein-4 at 11–13 weeks' gestation in normal and pathological pregnancies. Metabolism 2013; 626: 814–9.
41. Giguere Y, Masse J, Theriault S et al. Screening for pre-eclampsia early in pregnancy: performance of a multivariable model combining clinical characteristics and biochemical markers. BJOG 2015; 122: 402–10.
42. Poon LC, Maiz N, Valencia C et al. First-trimester maternal serum pregnancy-associated plasma protein-A and pre-eclampsia. Ultrasound Obstet Gynecol 2009; 33: 23–33.
43. Powers RW, Roberts JM, Plymire DA et al. Low placental growth factor across pregnancy identifies a subset of women with preterm preeclampsia: type 1 versus type 2 preeclampsia? Hypertension 2012; 60: 239–46.
44. Dubrovina S.O., Mutsalkhanova Iu.S., Tikidzhieva V.Iu. Poisk rannikh prognosticheskikh markerov preeklampsii. Tavricheskii mediko-biologich. vestn. 2016; 19 (2): 62–4. [in Russian]
Авторы
С.О.Дубровина*1, 2, Ю.С.Муцалханова1
1. ГБОУ ВПО Ростовский государственный медицинский университет Минздрава России. 344022, Россия, Ростов-на-Дону, Нахичеванский пер., д. 29;
2. ФГБУ Ростовский научно-исследовательский институт акушерства и педиатрии Минздрава России. 344012, Россия, Ростов-на-Дону, ул. Мечникова, д. 43
*s.dubrovina@gmail.com
________________________________________________
S.O.Dubrovina*1, 2, Yu.S.Mutsalkhanova2
1. Rostov State Medical University of the Ministry of Health of the Russian Federation. 344022, Russian Federation, Rostov-on-Don, per. Nakhichevanskii, d. 29;
2. Rostov-on-Don Scientific Research Institute of Obstetrics and Pediatrics of the Ministry of Health the Russian Federation. 344012, Russian Federation, Rostov-on-don, ul. Mechnikova, d. 43
*s.dubrovina@gmail.com