{"id":11799,"date":"2020-05-06T00:15:44","date_gmt":"2020-05-05T21:15:44","guid":{"rendered":"https:\/\/www.synevo.ro\/shop\/markeri-preeclampsie\/"},"modified":"2025-02-06T12:09:04","modified_gmt":"2025-02-06T10:09:04","slug":"markeri-preeclampsie","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/markeri-preeclampsie\/","title":{"rendered":"\u041c\u0430\u0440\u043a\u0435\u0440\u044b \u043f\u0440\u0435\u044d\u043a\u043b\u0430\u043c\u043f\u0441\u0438\u0438"},"content":{"rendered":"<p><strong><em>Informa\u021bii generale <\/em><\/strong><strong><em>\u0219i recomand\u0103ri pentru efectuarea markerilor de preeclampsie<\/em><\/strong><\/p>\n<div id=\"tab-description\" class=\"woocommerce-Tabs-panel woocommerce-Tabs-panel--description panel entry-content wc-tab\" role=\"tabpanel\" aria-labelledby=\"tab-title-description\">\n<p>Testul este compus din urm\u0103toarele:<\/p>\n<ul>\n<li><strong>Factorul de crestere placentar (PlGF)<\/strong><\/li>\n<li><strong>Tirozin kinaza-1 fms-like solubila (sFLt-1)<\/strong><\/li>\n<li><strong>Raport sFlt-1\/PlGF<\/strong><\/li>\n<\/ul>\n<p><strong><em>\u00a0<\/em><\/strong><u>Defini\u021bii \u0219i epidemiologie<\/u><\/p>\n<p>Preeclampsia (PE) este o afec\u021biune hipertensiv\u0103 specific\u0103 sarcinii cu afectare multisistemic\u0103 ce este caracterizat\u0103 prin hipertensiune arterial\u0103 (HTA) \u0219i proteinurie <em>de novo<\/em> ap\u0103rute dup\u0103 s\u0103pt\u0103m\u00e2na 20 de sarcin\u0103. De\u0219i defini\u021bia clasic\u0103 a PE include prezen\u021ba celor dou\u0103 criterii (HTA \u0219i proteinurie), unele gravide manifest\u0103 HTA \u0219i semne de afectare multisistemic\u0103 ce indic\u0103 severitatea bolii f\u0103r\u0103 ca proteinuria s\u0103 fie detectat\u0103.<\/p>\n<p>De aceea, \u00een absen\u021ba proteinuriei, PE este diagnosticat\u0103 pe baza HTA asociat\u0103 cu trombocitopenie (nr. de trombocite &lt; 100 000\/\u03bcL), semne de disfunc\u021bie hepatic\u0103 (dublarea nivelului transaminazelor serice fa\u021b\u0103 de valorile de referin\u021b\u0103), apari\u021bia <em>de novo<\/em> a unei disfunc\u021bii renale (valori ale creatininei serice peste 1.1 mg\/dL sau dublarea nivelului creatininei serice \u00een absen\u021ba unei boli renale), edem pulmonar, sau tulbur\u0103ri cerebrale\/vizuale recent instalate<sup>1;2<\/sup>.<\/p>\n<p>HTA este definit\u0103 fie printr-o TA sistolic\u0103 \u2265 140 mm Hg sau diastolic\u0103 \u2265 90 mm Hg, fie prin ambele. Proteinuria este diagnosticat\u0103 \u00een prezen\u021ba unei excre\u021bii urinare \u2265 300 mg\/24 h sau a unui raport proteine\/creatinin\u0103 \u22653, m\u0103surat \u00eentr-o prob\u0103 de urin\u0103 spontan\u0103. Testarea calitativ\u0103 a proteinuriei cu strip-urile urinare are o rat\u0103 ridicat\u0103 de rezultate fals-pozitive \u0219i fals-negative \u0219i de aceea va fi rezervat\u0103 doar cazurilor \u00een care determin\u0103rile cantitative nu sunt disponibile<sup>2<\/sup>. Formele de PE sever\u0103 includ oricare din urm\u0103toarele semne \u0219i simptome:<\/p>\n<ul>\n<li>TA sistolic\u0103 \u2265 160 mm Hg sau diastolic\u0103 \u2265 110 mm Hg la dou\u0103 m\u0103sur\u0103tori efectuate la interval de minimum 6 h, la gravidele c\u0103rora li s-a recomandat repaus la pat;<\/li>\n<li>Prezen\u021ba trombocitopeniei (nr. de trombocite &lt; 100 000\/\u03bcL);<\/li>\n<li>Prezen\u021ba semnelor de afectare multisistemic\u0103 (men\u021bionate mai sus)<sup>2<\/sup>.<\/li>\n<\/ul>\n<p>PE apare la 2-8% din sarcini \u0219i conduce la o morbiditate \u0219i mortalitate matern\u0103 \u0219i fetal\u0103 semnificative. Astfel, PE reprezint\u0103 o cauz\u0103 major\u0103 de prematuritate extrem\u0103 (20% din na\u0219terile premature &lt; 32 s\u0103pt\u0103m\u00e2ni) \u0219i determin\u0103 de asemenea aproximativ 76000 decese materne pe an, \u00een \u00eentreaga lume. Nu \u00een ultimul r\u00e2nd, PE constituie un factor de risc pentru dezvoltarea \u00een viitor de afec\u021biuni cardiovasculare \u0219i metabolice. P\u00e2n\u0103 \u00een prezent nu exist\u0103 niciun tratament curativ. Doar inducerea travaliului \u0219i \u00eendep\u0103rtarea placentei amelioreaz\u0103 simptomatologia matern\u0103 iar internarea rapid\u0103 \u00een centre specializate reduce cu morbiditatea \u0219i mortalitatea perinatal\u0103 cu 20%<sup>3<\/sup>.<\/p>\n<p>\u00cen majoritatea cazurilor, PE apare la femeile aflate la prima sarcin\u0103. \u00cen plus, unele afec\u021biuni medicale asociaz\u0103 un risc mai mare de preeclampsie, precum HTA, diabetul zaharat \u0219i bolile renale.<\/p>\n<p>PE se poate dezvolta dup\u0103 s\u0103pt\u0103m\u00e2na 20 de sarcin\u0103 \u0219i p\u00e2n\u0103 la 48 h postpartum; cel mai frecvent este \u00eens\u0103 diagnosticat\u0103 dup\u0103 34 s\u0103pt\u0103m\u00e2ni de gesta\u021bie. Boala declan\u0219at\u0103 timpuriu (&lt; 34 s\u0103pt\u0103m\u00e2ni) este \u00eenso\u021bit\u0103 de un risc perinatal \u0219i complica\u021bii materne mai mari<sup>1;2<\/sup>.<\/p>\n<p><u>Mecanisme patogenice \u2013 rolul factorilor angiogenici<\/u><\/p>\n<p>De\u0219i mecanismul patogenic al preeclampsiei nu este complet elucidat, se consider\u0103 c\u0103 manifest\u0103rile clinice ale bolii sunt rezultatul r\u0103spunsului matern la placenta\u021bia anormal\u0103. Mai mul\u021bi factori imunologici \u0219i genetici sunt implica\u021bi precoce \u00een sarcin\u0103, al\u0103turi de ischemia placentei, stresul oxidativ \u0219i al\u021bi factori ce conduc la anomalii vasculare, disfunc\u021bia celulelor trofoblastice, implantarea anormal\u0103 a placentei \u0219i rezisten\u021ba crescut\u0103 la nivelul arterelor uterine. Hipoperfuzia placentei \u0219i stresul oxidativ local vor genera compu\u0219i polipeptidici activi ce vor ajunge \u00een circula\u021bia matern\u0103 \u0219i vor produce un spasm al arterelor sistemice mici, cu ischemia organelor \u021bint\u0103<sup>4<\/sup>.<\/p>\n<p>La \u00eenceputul acestei decade, mai multe studii diferite au ar\u0103tat c\u0103 gravidele afectate de PE prezint\u0103 un <strong>dezechilibru \u00eentre factorii plasmatici solubili antiangiogenici \u0219i cei proangiogenici<\/strong>, acesta conduc\u00e2nd la o disfunc\u021bie endotelial\u0103 generalizat\u0103. Factorii proangiogenici circulan\u021bi secreta\u021bi de placent\u0103 includ VEGF (factorul de cre\u0219tere a endoteliului vascular) \u0219i PIGF (factorul de\u00a0 cre\u0219tere placentar), \u00een timp ce factorii antiangiogenici sunt reprezenta\u021bi de sFlt1 (tirozin kinaz\u0103-1 fms solubil\u0103 sau receptorul 1 pentru factorul de\u00a0 cre\u0219tere a endoteliului vascular VEGFR-1) \u0219i sEng (endoglina solubil\u0103).<\/p>\n<p>VEGF \u0219i PIGF promoveaz\u0103 angiogeneza prin interac\u021biunea cu familia de receptori ai VEGF. De\u0219i ambii factori sunt produ\u0219i de placent\u0103, \u00een sarcin\u0103 se \u00eenregistreaz\u0103 cre\u0219teri semnificativ mai mari de PIGF. Astfel, \u00een sarcina normal\u0103 concentra\u021biile serice de PlGF cresc \u00een primele dou\u0103 trimestre \u0219i scad pe m\u0103sur\u0103 ce sarcina se apropie de termen, acest factor asigur\u00e2nd func\u021bionarea adecvat\u0103 a placentei. sFlt-1 reprezint\u0103 o izoform\u0103 solubil\u0103 a Flt-1, receptorul transmembranar al VEGF. De\u0219i receptorului sFlt-1 \u00eei lipse\u0219te domeniul transmembranar, acesta con\u021bine regiunea de ata\u0219are a ligandului \u0219i este capabil s\u0103 lege factorii VEGF \u0219i PlGF.<\/p>\n<p>Prin blocarea interac\u021biunii acestor factori de cre\u0219tere cu receptorii transmembranari sFlt-1 exercit\u0103 un efect antiangiogenic. \u00cen mod fiziologic, concentra\u021biile sFlt-1 r\u0103m\u00e2n stabile \u00een stadiile timpurii \u0219i mijlocii ale gesta\u021biei \u0219i cresc constant p\u00e2n\u0103 la termen, ceea ce explic\u0103 rolul acestei proteine \u00een \u00eentreruperea sarcinii \u00een ultimile s\u0103pt\u0103m\u00e2ni de gesta\u021bie.<\/p>\n<p>La gravidele cu o remodelare vascular\u0103 uterin\u0103 anormal\u0103 statusul hipoxic al placentei este responsabil de eliberarea \u00een circula\u021bia matern\u0103 a unor cantit\u0103\u021bi foarte mari de sFlt-1 (figura 1), av\u00e2nd ca rezultat sc\u0103derea biodisponibilit\u0103\u021bii VEGF \u0219i PlGF \u0219i, consecutiv, inhibarea efectelor acestora asupra endoteliului matern<sup>5;6;7<\/sup>. A\u0219a cum au demonstrat studiile efectuate pe modele animale, cre\u0219terea nivelurilor sFlt-1 \u00een circula\u021bie \u0219i sc\u0103derea biodisponibilit\u0103\u021bii PlGF vor avea ca rezultat apari\u021bia semnelor caracteristice PE (HTA, proteinurie), ilustr\u00e2nd rolul acestor factori \u00een patogenia PE<sup>8<\/sup>.<\/p>\n<p><img decoding=\"async\" class=\"size-full wp-image-32386 aligncenter lazyloaded\" src=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2018\/10\/markeri-preeclampsie.png\" alt=\"Markeri preeclampsie - Synevo\" width=\"1019\" height=\"478\" data-src=\"\/wp-content\/uploads\/2018\/10\/markeri-preeclampsie.png\" \/><\/p>\n<p><img decoding=\"async\" class=\"size-full wp-image-32386 aligncenter ls-is-cached lazyloaded\" src=\"https:\/\/www.synevo.ro\/wp-content\/uploads\/2018\/10\/markeri-preeclampsie.png\" alt=\"Markeri preeclampsie - Synevo\" width=\"1019\" height=\"478\" data-src=\"\/wp-content\/uploads\/2018\/10\/markeri-preeclampsie.png\" \/><\/p>\n<p><strong>Figura 1. Factorii angiogenici placentari \u00een preeclampsie<\/strong><\/p>\n<p>(<em>Adaptare dup\u0103 Lecarpentier E, Tsatsaris V, 2016)<\/em><\/p>\n<p>\u041d<u>ecesitatea \u00eembun\u0103t\u0103\u021birii diagnosticului \u0219i managementului gravidelor cu PE<\/u><\/p>\n<p>Diagnosticul PE se bazeaz\u0103 pe apari\u021bia HTA \u0219i a proteinuriei \u00een trimestrul II de sarcin\u0103, de\u0219i prezen\u021ba acestora nu precede \u00eentotdeauna debutul complica\u021biilor \u0219i nu are valoare predictiv\u0103 asupra modului de evolu\u021bie a PE. Aceste limit\u0103ri conduc la o diagnosticare a PE \u00eentr-un stadiu avansat de boal\u0103 \u0219i posibil la complica\u021bii severe materne \u0219i fetale. Pe de alt\u0103 parte, multe gravide cu semne \u0219i simptome de PE sunt spitalizate \u00een mod nenecesar \u00een vederea monitoriz\u0103rii, spitalizarea reprezent\u00e2nd un factor de stres pentru paciente.<\/p>\n<p>Din aceste motive, este necesar s\u0103 se implementeze teste de diagnostic <em>in vitro<\/em>, cum ar fi raportul sFlt-1\/PlGF, pentru a \u00eembun\u0103t\u0103\u021bi capacitatea de predic\u021bie, diagnosticul \u0219i prognosticul pacientelor cu PE<sup>9<\/sup>.<\/p>\n<p><u>Valoarea predictiv\u0103 \u0219i diagnostic\u0103 a raportului sFlt-1\/PlGF<\/u><\/p>\n<p>Studiile prospective longitudinale au ar\u0103tat c\u0103 gravidele care vor dezvolta PE prezint\u0103 niveluri circulante sFlt-1 crescute \u0219i PlGF sc\u0103zute cu c\u00e2teva s\u0103pt\u0103m\u00e2ni \u00eenainte de debutul clinic a bolii, comparativ cu gravidele care au evolu\u021bie normal\u0103 a sarcinii. \u00cen plus, <strong>raportul sFlt-1\/PlGF se coreleaz\u0103 cu severitatea PE<\/strong><sup>10<\/sup>.<\/p>\n<p>\u00centr-un studiu prospectiv multicentric de tip observa\u021bional (PROGNOSIS) ce a inclus 500 gravide cu v\u00e2rst\u0103 a sarcinii \u00eentre 24 +0 \u0219i 36 + 6 s\u0103pt\u0103m\u00e2ni \u0219i suspiciune clinic\u0103 de PE, a fost identificat\u0103 o valoare cut-off a raportului sFlt-1\/PlGF de 38 ca av\u00e2nd o relevan\u021b\u0103 predictiv\u0103 important\u0103. \u00centr-o etap\u0103 ulterioar\u0103 de validare a studiului pe un lot adi\u021bional de 550 gravide, un raport sFlt-1\/PlGF \u2264 38 a avut o valoare predictiv\u0103 negativ\u0103 (VPN) de 99.3% privind absen\u021ba PE \u00een urm\u0103toarea s\u0103pt\u0103m\u00e2n\u0103 de la momentul test\u0103rii.<\/p>\n<p>Pe de alt\u0103 parte, un raport sFlt-1\/PlGF &gt; 38 a avut o valoare predictiv\u0103 pozitiv\u0103 (VPP) de 36.7%, sensibilitate de 66.2% \u0219i specificitate de 78.3% \u00een ceea ce prive\u0219te dezvoltarea PE \u00een urm\u0103toarele 4 s\u0103pt\u0103m\u00e2ni, subliniindu-se astfel valoarea predictiv\u0103 a sFlt-1\/PlGF pe termen scurt<sup>11<\/sup>. \u00centr-o analiz\u0103 post-hoc a datelor ob\u021binute din studiul PROGNOSIS s-a ar\u0103tat c\u0103 un raport sFlt-1\/PlGF \u2264 38 poate exclude PE \u00een urm\u0103toarele 2, 3 \u0219i 4 s\u0103pt\u0103m\u00e2ni de la testarea ini\u021bial\u0103, av\u00e2nd o VPN negativ\u0103 de 97.9%, 95.7% \u0219i respectiv 94.3%. De asemenea, s-a constatat c\u0103 gravidele care au dezvoltat PE \u0219i\/sau evolu\u021bie nefavorabil\u0103 a f\u0103tului au prezentat o cre\u0219tere semnificativ\u0103 a raportului sFlt-1\/PlGF la repetarea test\u0103rii dup\u0103 2-3 s\u0103pt\u0103m\u00e2ni de la determinarea ini\u021bial\u0103<sup>12<\/sup>.<\/p>\n<p>Raportul sFlt-1\/PlGF a fost aprobat pentru utilizarea \u00een diagnosticul PE \u00eempreun\u0103 cu celelalte date clinice. A fost inclus \u00een ghidul german pentru diagnosticul afec\u021biunilor hipertensive<sup>13<\/sup> \u0219i de asemenea \u00een ghidul NICE (National Institute for Health and Care Excellence, UK) ca instrument de excludere a PE la gravidele cu v\u00e2rst\u0103 a sarcinii \u00eentre\u00a0 20 \u0219i 34+6 s\u0103pt\u0103m\u00e2ni<sup>14<\/sup>.<\/p>\n<p><u>Aplica\u021biile clinice ale raportului sFlt-1\/PlGF<\/u><\/p>\n<p><em>Predic\u021bia sau excluderea PE la gravidele cu factori de risc<\/em><\/p>\n<p>Principalii factori de risc pentru PE sunt urm\u0103torii:<\/p>\n<ul>\n<li>preeclampsie anterioar\u0103;<\/li>\n<li>sarcin\u0103 multipl\u0103;<\/li>\n<li>condi\u021bii medicale preexistente: HTA, boal\u0103 cronic\u0103 de rinichi, diabet zaharat tip 1, sindrom antifosfolipidic, lupus<\/li>\n<\/ul>\n<p>eritematos sisemic.<\/p>\n<ul>\n<li>primiparitate;<\/li>\n<li>antecedente familiale de preeclampsie (mam\u0103 sau sor\u0103);<\/li>\n<li>obezitate;<\/li>\n<li>v\u00e2rsta \u2265 40 ani;<\/li>\n<li>istoric de trombofilie;<\/li>\n<li>fertilizarea <em>in vitro<\/em>;<\/li>\n<li>velocimetrie Doppler a arterelor uterine modificat\u0103 (dup\u0103 s\u0103pt\u0103m\u00e2na 24)<sup>2;5;15<\/sup>.<\/li>\n<\/ul>\n<p><em>Triajul pacientelor cu <\/em><em>afec\u021biuni hipertensive asociate sarcinii<\/em><\/p>\n<p>Determinarea raportului sFlt-1\/PIGF poate fi util\u0103 la gravidele cu HTA pentru a evalua necesitatea spitaliz\u0103rii, mai ales dac\u0103:<\/p>\n<ul>\n<li>sunt prezente simptome sau semne nespecifice de PE (durere epigastric\u0103, edem facial, cre\u0219tere brusc\u0103 \u00een greutate, cefalee, tulbur\u0103ri de vedere, trombocitopenie, cre\u0219terea transaminazelor serice);<\/li>\n<li>este necesar diagnosticul diferen\u021bial cu alte afec\u021biuni caracterizate prin proteinurie (boal\u0103 cronic\u0103 de rinichi ce a devenit manifest\u0103 \u00een cursul sarcinii);<\/li>\n<li>este necesar diagnosticul diferen\u021bial \u00eentre o patologie cronic\u0103 \u0219i PE care s-a dezvoltat pe acest fond;<\/li>\n<li>a fost diagnosticat\u0103 o restric\u021bie de cre\u0219tere intrauterin\u0103<sup>5<\/sup>.<\/li>\n<\/ul>\n<p><em>Evaluarea severit\u0103\u021bii bolii<\/em><\/p>\n<p>La pacientele spitalizate raportul sFlt-1\/PIGF poate fi repetat dup\u0103 48 ore: cre\u0219terea brusc\u0103 a raportului indic\u0103 o agravare a condi\u021biei clinice, \u00een timp ce o valoare stabil\u0103 asigur\u0103 medicul obstetrician c\u0103 starea pacientei nu se va deteriora rapid \u0219i permite repetarea testului dup\u0103 2 s\u0103pt\u0103m\u00e2ni<sup>5<\/sup>.<\/p>\n<p><em>Predic\u021bia unei evolu\u021bii nefavorabile materne sau fetale<\/em><\/p>\n<p>La pacientele spitalizate m\u0103surarea repetat\u0103 a raportului sFlt-1\/PIGF poate stratifica gravidele \u00een func\u021bie de riscul moderat, mare \u0219i foarte mare de a dezvolta o complica\u021bie<sup>5<\/sup>.<\/p>\n<p><strong><em>Specimen recoltat <\/em><\/strong><em>- <\/em>\u0432\u0435\u043d\u043e\u0437\u043d\u0430\u044f \u043a\u0440\u043e\u0432\u044c<sup>16<\/sup>.<\/p>\n<p><strong><em>Recipient de recoltare <\/em><\/strong><em>- <\/em>vacutainer f\u0103r\u0103 anticoagulant, cu\/f\u0103r\u0103 gel separator<sup>16<\/sup>.<\/p>\n<p><strong><em>Prelucrare necesar\u0103 dup\u0103 recoltare<\/em><\/strong> \u2013 se separ\u0103 serul prin centrifugare;<\/p>\n<p><strong><em>Volum prob\u0103<\/em><\/strong> \u2013 minim 1 mL ser<sup>16<\/sup>.<\/p>\n<p><strong><em>Cauze de respingere<\/em><\/strong> <strong><em>a probei<\/em><\/strong><\/p>\n<ul>\n<li>specimen hemolizat;<\/li>\n<li>specimen expus la temperatur\u0103 ridicat\u0103 sau contaminat bacterian<sup>16<\/sup>.<\/li>\n<\/ul>\n<p><strong><em>Stabilitate prob\u0103 <\/em><\/strong><em>- <\/em>serul este stabil 48 ore la 2-8\u00b0C sau 1 luna la -20\u00b0C, probele nu pot fi recongelate.<\/p>\n<p><strong><em>Metod\u0103 <\/em><\/strong>- <u>FIA<\/u>.<\/p>\n<p><strong><em>Limita de detec\u021bie<\/em><\/strong> \u2013 10 pg\/mL (sFlt-1); 3 pg\/mL (PIGF)<sup>16<\/sup>.<\/p>\n<p><strong><em>Valori de referin\u021b\u0103 \u0219i interpretarea rezultatelor <\/em><\/strong><\/p>\n<p>Sunt furnizate valori de referin\u021b\u0103 pentru ambii markeri de PE<sup>16<\/sup>:<\/p>\n<table class=\"wp-block-table w-100\">\n<tbody>\n<tr>\n<td width=\"219\"><strong>S\u0103pt\u0103m\u00e2ni de sarcin\u0103<\/strong><\/td>\n<td width=\"226\"><strong>sFlt-1<\/strong><\/td>\n<td width=\"216\"><strong>PlGF<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"219\">14-19<\/td>\n<td width=\"226\">764 \u2013 2545<\/td>\n<td width=\"216\">43-348<\/td>\n<\/tr>\n<tr>\n<td width=\"219\">20-24<\/td>\n<td width=\"226\">626 \u2013 4443<\/td>\n<td width=\"216\">183 \u2013 868<\/td>\n<\/tr>\n<tr>\n<td width=\"219\">25-28<\/td>\n<td width=\"226\">612 \u2013 3958<\/td>\n<td width=\"216\">145 \u2013 1000<\/td>\n<\/tr>\n<tr>\n<td width=\"219\">29-33<\/td>\n<td width=\"226\">697 \u2013 3722<\/td>\n<td width=\"216\">71 \u2013 1157<\/td>\n<\/tr>\n<tr>\n<td width=\"219\">34-36<\/td>\n<td width=\"226\">1023 \u2013 8492<\/td>\n<td width=\"216\">41 \u2013 752<\/td>\n<\/tr>\n<tr>\n<td width=\"219\">&gt; 37<\/td>\n<td width=\"226\">961 \u2013 7524<\/td>\n<td width=\"216\">37 \u2013 750<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><u>Interpretarea raportului <\/u><u>sFlt-1\/PIGF<\/u><sup>16;17<\/sup><\/p>\n<p>PE cu debut precoce (v\u00e2rsta gesta\u021bional\u0103 20 \u2013 33 + 6 s\u0103pt\u0103m\u00e2ni)<\/p>\n<table class=\"wp-block-table w-100\">\n<tbody>\n<tr>\n<td width=\"104\"><strong>Raport\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><strong>sFlt-1\/PIGF<\/strong><\/td>\n<td width=\"246\"><strong>Interpretare<\/strong><\/td>\n<td width=\"312\"><strong>Management<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"104\">&lt;38<\/td>\n<td width=\"246\">Excluderea PE \u00een urm\u0103toarea s\u0103pt\u0103m\u00e2n\u0103 cu o VPN de \u224899% \u0219i \u00een urm\u0103toarele 4 s\u0103pt\u0103m\u00e2ni cu o VPN de \u224895%<\/td>\n<td width=\"312\">Pacienta prezint\u0103 un risc minim de a dezvolta PE \u00een urm\u0103toarele 4 s\u0103pt\u0103m\u00e2ni. Nu este necesar\u0103 repetarea test\u0103rii dec\u00e2t \u00een situa\u021bia \u00een care apare o nou\u0103 suspiciune clinic\u0103 de PE.<\/td>\n<\/tr>\n<tr>\n<td width=\"104\">38-85<\/td>\n<td width=\"246\">Pacienta prezint\u0103 un risc crescut de PE (VPP \u224840%)<\/td>\n<td width=\"312\">Monitorizare \u0219i retestare dup\u0103 1-2 s\u0103pt\u0103m\u00e2ni. Pacienta va fi informat\u0103 cu privire la simptomele de PE (doar 20% din paciente vor men\u021bine sarcina dup\u0103 1 lun\u0103).<\/td>\n<\/tr>\n<tr>\n<td width=\"104\">&gt;85<\/td>\n<td width=\"246\">Probabilitate mare de PE (sensibilitate 88%, specificitate 99.5%)<\/td>\n<td width=\"312\">Spitalizare \u0219i retestare dup\u0103 2-4 zile (doar 15% din paciente vor men\u021bine sarcina dup\u0103 2 s\u0103pt\u0103m\u00e2ni).<\/td>\n<\/tr>\n<tr>\n<td width=\"104\">&gt;655<\/td>\n<td width=\"246\">Risc foarte mare de complica\u021bii pe termen scurt \u0219i necesitate de provocare a travaliului<\/td>\n<td width=\"312\">Monitorizare atent\u0103 \u00een spital, administrare de corticosteroizi pentru accelerarea matur\u0103rii pulmonare fetale (doar 30% din gravide vor men\u021bine sarcina dup\u0103 2 zile).<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>PE cu debut tardiv (v\u00e2rsta gesta\u021bional\u0103 &gt;34 s\u0103pt\u0103m\u00e2ni)<\/p>\n<table class=\"wp-block-table w-100\">\n<tbody>\n<tr>\n<td width=\"104\"><strong>Raport\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><strong>sFlt-1\/PIGF<\/strong><\/td>\n<td width=\"246\"><strong>Interpretare<\/strong><\/td>\n<td width=\"312\"><strong>Management<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"104\">&lt;38<\/td>\n<td width=\"246\">Excluderea PE \u00een urm\u0103toarea s\u0103pt\u0103m\u00e2n\u0103 cu o VPN de \u224899% \u0219i \u00een urm\u0103toarele 4 s\u0103pt\u0103m\u00e2ni cu o VPN de \u224895%<\/td>\n<td width=\"312\">Pacienta prezint\u0103 un risc minim de a dezvolta PE \u00een urm\u0103toarele 4 s\u0103pt\u0103m\u00e2ni. Nu este necesar\u0103 repetarea test\u0103rii dec\u00e2t \u00een situa\u021bia \u00een care apare o nou\u0103 suspiciune clinic\u0103 de PE.<\/td>\n<\/tr>\n<tr>\n<td width=\"104\">38-110<\/td>\n<td width=\"246\">Pacienta prezint\u0103 un risc crescut de PE (VPP \u224840%)<\/td>\n<td width=\"312\">Monitorizare \u0219i retestare dup\u0103 1-2 s\u0103pt\u0103m\u00e2ni. Pacienta va fi informat\u0103 cu privire la simptomele de PE (doar 20% din paciente vor men\u021bine sarcina dup\u0103 1 lun\u0103).<\/td>\n<\/tr>\n<tr>\n<td width=\"104\">&gt;110<\/td>\n<td width=\"246\">Probabilitate mare de PE (sensibilitate 58.2%, specificitate 99.5%)<\/td>\n<td width=\"312\">Spitalizare \u0219i retestare dup\u0103 2-4 zile (doar 15% din paciente vor men\u021bine sarcina dup\u0103 2 s\u0103pt\u0103m\u00e2ni).<\/td>\n<\/tr>\n<tr>\n<td width=\"104\">&gt;201<\/td>\n<td width=\"246\">Risc foarte mare de complica\u021bii pe termen scurt \u0219i necesitate de provocare a travaliului<\/td>\n<td width=\"312\">Monitorizare atent\u0103 \u00een spital (doar 30% din gravide vor men\u021bine sarcina dup\u0103 2 zile).<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong><em>Limite<\/em><\/strong> <strong><em>\u0219i interferen\u021be<\/em><\/strong><\/p>\n<ul>\n<li>Interferen\u021be analitice<\/li>\n<\/ul>\n<p>Pot produce interferen\u021be cu unele componente ale kit-ului \u0219i conduce la rezultate neconcludente urm\u0103toarele:<\/p>\n<ul>\n<li>tratamentul cu biotin\u0103 \u00een doze mari (&gt;5 mg\/zi); de aceea se recomand\u0103 ca recoltarea de s\u00e2nge s\u0103 se fac\u0103 dup\u0103 minimum 8 ore de la ultima administrare;<\/li>\n<li>titrurile foarte crescute de anticorpi anti-streptavidin\u0103 \u0219i anti-ruteniu<sup>16<\/sup>.<\/li>\n<\/ul>\n<p><strong>\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/strong><\/p>\n<ol>\n<li>Wu P, van den Berg C, Alfirevic Z, O\u2019Brien S, R\u00f6thlisberger M, Baker PN, Kenny LC, Kublickiene K, Duvekot JJ. Early Pregnancy Biomarkers in Pre-Eclampsia: A Systematic Review and Meta-Analysis. Int J Mol Sci. 2015 Sep 23;16(9):23035-56.<\/li>\n<li>American College of Obstetricians and Gynecologists. Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists\u2019 Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013;122:1122\u201331.<\/li>\n<li>Steegers E.A.P., von Dadelszen P., Duvekot J.J., Pijnenborg R. Pre-eclampsia. Lancet. 2010 Aug 21;376(9741):631-44.<\/li>\n<li>Li L, Zheng Y, Zhu Y, Li J. Serum biomarkers combined with uterine artery Doppler in prediction of preeclampsia. Exp Ther Med. 2016 Oct;12(4):2515-2520.<\/li>\n<li>Di Martino D, Cetin I, Frusca T, Ferrazzi E, Fuse\u2019 F, Gervasi MT, Plebani M, Todros T. Italian Advisory Board: sFlt-1\/PlGF ratio and preeclampsia, state of the art and developments in diagnostic, therapeutic and clinical management.<\/li>\n<li>Lecarpentier E, Tsatsaris V. Angiogenic balance (sFlt-1\/PlGF) and preeclampsia. Ann Endocrinol (Paris). 2016 Jun;77(2):97-100.<\/li>\n<li>Tardif C, Dumontet E, Caillon H, Misbert E, Dochez V, Masson D, Winer N. Angiogenic factors sFlt-1 and PlGF in preeclampsia: Prediction of risk and prognosis in a high-risk obstetric population. J Gynecol Obstet Hum Reprod. 2018 Jan;47(1):17-21.<\/li>\n<li>Maynard SE, Min JY, Merchan J, Lim KH, Li J, Mondal S, Libermann TA, Morgan JP, Sellke FW, Stillman IE, Epstein FH, Sukhatme VP, Karumanchi SA. Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Invest. 2003 Mar;111(5):649-58.<\/li>\n<li>Herraiz I, Llurba E, Verlohren S, Galindo A; Spanish Group for the Study of Angiogenic Markers in Preeclampsia. Update on the Diagnosis and Prognosis of Preeclampsia with the Aid of the sFlt-1\/ PlGF Ratio in Singleton Pregnancies. Fetal Diagn Ther. 2018;43(2):81-89.<\/li>\n<li>Levine RJ, Maynard SE, Qian C, Lim KH, England LJ, Yu KF, Schisterman EF, Thadhani R, Sachs BP, Epstein FH, Sibai BM, Sukhatme VP, Karumanchi SA. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2004 Feb 12;350(7):672-83. Eur J Obstet Gynecol Reprod Biol. 2016 Nov;206:70-73.<\/li>\n<li>Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennstr\u00f6m M, Olovsson M, Brennecke SP, Stepan H, Allegranza D, Dilba P, Schoedl M, Hund M, Verlohren S. Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia. N Engl J Med. 2016 Jan 7;374(1):13-22.<\/li>\n<li>Zeisler H, Llurba E, Chantraine FJ, Vatish M, Staff AC, Sennstr\u00f6m M, Olovsson M, Brennecke SP, Stepan H, Allegranza D, Schoedl M, Grill S, Hund M, Verlohren S. The sFlt-1\/PlGF Ratio: ruling out pre-eclampsia for up to 4 weeks and the value of retesting. Ultrasound Obstet Gynecol. 2018 Jul 16.<\/li>\n<li>German guideline. Available at: <a href=\"https:\/\/www.awmf.org\/uploads\/tx_szleitli-nien\/015 018l_S1_Diagnostik_Therapie_hypertensiver_Schwangerschaftserk-rankungen_2014-01.pdf\" target=\"_blank\" rel=\"noopener nofollow external noreferrer\" data-wpel-link=\"external\">https:\/\/www.awmf.org\/uploads\/tx_szleitli-nien\/015 018l_S1_Diagnostik_Therapie_hypertensiver_Schwangerschaftserk-rankungen_2014-01.pdf<\/a><\/li>\n<li>NICE National Institute for Health and Care Excellence guidelines: PlGF-based testing to help diagnose suspected pre-eclampsia (Triage PlGF test, Elecsys immunoassay sFlt-1\/PlGF ratio, DELFIA Xpress PlGF 1-2-3 test, and BRAHMS sFlt-1 Kryptor\/BRAHMS PlGF plus Kryptor PE ratio). May 2016.<\/li>\n<li>English FA, Kenny LC, McCarthy FP. Risk factors and effective management of preeclampsia. Integr Blood Press Control. 2015 Mar 3;8:7-12.<\/li>\n<li>Laborator Synevo. Referin\u021bele specifice tehnologiei de lucru utilizate 2018. Ref Type: Catalog.<\/li>\n<li>Stepan H, Herraiz I, Schlembach D, Verlohren S, Brennecke S, Chantraine F, Klein E, Lapaire O, Llurba E, Ramoni A, Vatish M, Wertaschnigg D, Galindo A. Implementation of the sFlt-1\/PlGF ratio for prediction and diagnosis of pre-eclampsia in singleton pregnancy: implications for clinical practice. Ultrasound Obstet Gynecol. 2015 Mar;45(3):241-6.<\/li>\n<\/ol>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>\u041f\u0440\u0435\u044d\u043a\u043b\u0430\u043c\u043f\u0441\u0438\u044f \u2013 \u043e\u0434\u043d\u043e \u0438\u0437 \u043e\u0447\u0435\u043d\u044c \u0441\u0435\u0440\u044c\u0435\u0437\u043d\u044b\u0445 \u043e\u0441\u043b\u043e\u0436\u043d\u0435\u043d\u0438\u0439 \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0438. \u042d\u0442\u043e\u0442 \u0432\u0438\u0434 \u043f\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u0438 \u043e\u0442\u043d\u043e\u0441\u0438\u0442\u0441\u044f \u043a \u0433\u0440\u0443\u043f\u043f\u0435 \u0433\u0438\u043f\u0435\u0440\u0442\u0435\u043d\u0437\u0438\u0432\u043d\u044b\u0445 \u0440\u0430\u0441\u0441\u0442\u0440\u043e\u0439\u0441\u0442\u0432 \u043f\u0440\u0438 \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0438, \u043a\u043e\u0442\u043e\u0440\u044b\u0435 \u044f\u0432\u043b\u044f\u044e\u0442\u0441\u044f \u043e\u0434\u043d\u043e\u0439 \u0438\u0437 \u0432\u0435\u0434\u0443\u0449\u0438\u0445 \u043f\u0440\u0438\u0447\u0438\u043d \u043c\u0430\u0442\u0435\u0440\u0438\u043d\u0441\u043a\u043e\u0439 \u0441\u043c\u0435\u0440\u0442\u043d\u043e\u0441\u0442\u0438, \u0430 \u0442\u0430\u043a\u0436\u0435 \u043f\u0440\u0438\u0447\u0438\u043d\u043e\u0439 \u0442\u044f\u0436\u0435\u043b\u043e\u0439 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u0435\u043c\u043e\u0441\u0442\u0438 \u043a\u0430\u043a \u043c\u0430\u0442\u0435\u0440\u0435\u0439, \u0442\u0430\u043a \u0438 \u043f\u043b\u043e\u0434\u0430. \u041f\u0440\u0435\u044d\u043a\u043b\u0430\u043c\u043f\u0441\u0438\u044f \u0445\u0430\u0440\u0430\u043a\u0442\u0435\u0440\u0438\u0437\u0443\u0435\u0442\u0441\u044f \u0441\u0442\u043e\u0439\u043a\u043e\u0439 \u0430\u0440\u0442\u0435\u0440\u0438\u0430\u043b\u044c\u043d\u043e\u0439 \u0433\u0438\u043f\u0435\u0440\u0442\u0435\u043d\u0437\u0438\u0435\u0439, \u0432\u043e\u0437\u043d\u0438\u043a\u0448\u0435\u0439 \u043f\u043e\u0441\u043b\u0435 20 \u043d\u0435\u0434\u0435\u043b\u044c \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u043e\u0441\u0442\u0438, \u0438 \u0437\u043d\u0430\u0447\u0438\u0442\u0435\u043b\u044c\u043d\u043e\u0439 \u043f\u0440\u043e\u0442\u0435\u0438\u043d\u0443\u0440\u0438\u0435\u0439 (\u043f\u043e\u0432\u044b\u0448\u0435\u043d\u0438\u0435\u043c \u0432\u044b\u0434\u0435\u043b\u0435\u043d\u0438\u044f \u0431\u0435\u043b\u043a\u0430 \u0441 \u043c\u043e\u0447\u043e\u0439). \u041d\u0435\u0440\u0435\u0434\u043a\u0438 \u043e\u0442\u0435\u043a\u0438, \u043f\u0440\u043e\u044f\u0432\u043b\u0435\u043d\u0438\u044f \u043f\u043e\u043b\u0438\u043e\u0440\u0433\u0430\u043d\u043d\u043e\u0439 \u0434\u0438\u0441\u0444\u0443\u043d\u043a\u0446\u0438\u0438, \u0437\u0430\u0442\u0440\u0430\u0433\u0438\u0432\u0430\u044e\u0449\u0438\u0435 \u043f\u043e\u0447\u043a\u0438, \u043f\u0435\u0447\u0435\u043d\u044c, \u0441\u0435\u0440\u0434\u0435\u0447\u043d\u043e-\u0441\u043e\u0441\u0443\u0434\u0438\u0441\u0442\u0443\u044e \u0441\u0438\u0441\u0442\u0435\u043c\u0443, \u0432\u043e\u0437\u043c\u043e\u0436\u043d\u044b \u0446\u0435\u0440\u0435\u0431\u0440\u0430\u043b\u044c\u043d\u044b\u0435 \u0438 \u0437\u0440\u0438\u0442\u0435\u043b\u044c\u043d\u044b\u0435 \u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u044f. \u0427\u0430\u0441\u0442\u043e\u0442\u0430 \u0440\u0430\u0437\u0432\u0438\u0442\u0438\u044f \u043f\u0440\u0435\u044d\u043a\u043b\u0430\u043c\u043f\u0441\u0438\u0438 \u0441\u0440\u0435\u0434\u0438 \u0431\u0435\u0440\u0435\u043c\u0435\u043d\u043d\u044b\u0445 \u0441\u043e\u0441\u0442\u0430\u0432\u043b\u044f\u0435\u0442 2-8%.<\/p>\n<p>\u0421 \u043a\u0430\u043a\u043e\u0439 \u0446\u0435\u043b\u044c\u044e \u043f\u0440\u043e\u0432\u043e\u0434\u044f\u0442 \u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u0435 \u0441\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0438 \u043a\u0440\u043e\u0432\u0438 \u043d\u0430 \u00ab\u041c\u0430\u0440\u043a\u0435\u0440\u044b \u0440\u0438\u0441\u043a\u0430 \u043f\u0440\u0435\u044d\u043a\u043b\u0430\u043c\u043f\u0441\u0438\u0438: sFlt-1, PlGF, \u0441\u043e\u043e\u0442\u043d\u043e\u0448\u0435\u043d\u0438\u0435 sFlt-1\/PlGF\u00bb<\/p>\n<p>\u041e\u043f\u0440\u0435\u0434\u0435\u043b\u0435\u043d\u0438\u0435 \u0443\u0440\u043e\u0432\u043d\u044f PlGF \u0438 sFlt\u20111 \u0432 \u0441\u044b\u0432\u043e\u0440\u043e\u0442\u043a\u0435 \u043a\u0440\u043e\u0432\u0438, \u043f\u0440\u043e\u0432\u043e\u0434\u0438\u043c\u043e\u0435 \u0432 \u0434\u043e\u043f\u043e\u043b\u043d\u0435\u043d\u0438\u0435 \u043a \u0441\u0442\u0430\u043d\u0434\u0430\u0440\u0442\u043d\u044b\u043c \u0432\u0438\u0434\u0430\u043c \u043e\u0431\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044f, \u043f\u043e\u0437\u0432\u043e\u043b\u044f\u0435\u0442 \u043e\u0442\u043b\u0438\u0447\u0438\u0442\u044c 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