| Summary: | 碩士 === 國立臺灣大學 === 臨床醫學研究所 === 104 === Hypertensive disorders of pregnancy (HDP) are the leading causes of maternal mortality in developed countries. Additionally, one quarter of the babies born to mothers with preeclampsia, a severe HDP, are growth restricted and one third are premature. Early identification of HDP remains one of the major focuses of antenatal care. Evidence suggests that early administration of low-dose aspirin could reduce the incidence of preeclampsia. Much effort has been made to identify biomarkers that predict hypertensive disorders of pregnancy.
Vascular adhesion protein-1 (VAP-1), a 170-kDa transmembrane homodimer glycoprotein, is a vascular endothelial adhesion molecule involved in leukocyte rolling, adhesion, and transmigration into sites of inflammation. Changes in both serum VAP-1 concentration and activity have been reported in various vascular diseases. VAP-1 is also thought to be involved in neo-angiogenesis of various disease states.
We hypothesized that VAP-1 expression may be involved in the development of HDP and that serum VAP-1 concentration may be used as a predictive biomarker of HDP.
We conducted a prospective cohort study of pregnant women who underwent prenatal examination at National Taiwan University Hospital (NTUH) from 2013 through 2015. Among 541 patients recruited into the study, pregnancy outcome data were available in 480 patients. HDP developed in 26 (5.42%) subjects, of whom 12 (2.50%) had gestational hypertension and 14 (2.92%) had preeclampsia.
Mean VAP-1 serum concentration during the second trimester, before diagnosis of HDP, was significantly lower in HDP cases (267.92 ng/ml, SD=72.84) than in non-affected cases (307.20 ng/ml, SD = 61.14, P = 0.0023). First trimester VAP-1 serum concentration also showed a similar trend but with borderline significance (P = 0.11). The predictive value of second trimester VAP-1 serum concentration was evaluated by receiver-operating characteristic (ROC) curve analysis. When used alone, the area under the ROC curve (AUC) is 0.64 (95% CI, 0.57–0.80) for predicting HDP. When combined with a history of preeclampsia, history of hypertension, higher body mass index (BMI) before pregnancy, and twin pregnancy, AUC scored 0.83 (95% CI, 0.74–0.92) for predicting HDP.
In conclusion, effective screening for HDP can be provided by a combination of serum VAP-1 and maternal characteristics.
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