68 sFlt-1, PlGF and VEGF in differential diagnosis between preeclampsia and systemic lupus nephritis: Angiogenic factors

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• 作者：Guilherme Ribeiro Ramires de Jesus^a ; Adriana Paulino Do Nascimento^b ; Luí ; s Cristó ; vã ; o Porto^b ; Nilson Ramires De Jesú ; s^a ; Roger A. Levy^c ; Evandro Mendes Klumb^c
• 刊名：Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：6
• 期：3
• 页码：170
• 全文大小：38 K

文摘

Systemic lupus erythematosus (SLE) mainly affects young women and pregnancy in these patients has significant morbidity and mortality. Some features of SLE activity, specifically nephritis, are difficult to differentiate from preeclampsia (PE) in clinical practice. It has been proposed the use of angiogenic factors, such as vascular endothelial growth factor (VEGF) and placental growth factor (PlGF), and antiangiogenic factors, as soluble Fms-like tyrosine kinase-1 (sFlt-1), for the differential diagnosis between these two conditions, however there are no available data in the literature about these cytokines in pregnant patients with SLE.Objectives:The objective of this study was to evaluate whether there are differences between serum levels of VEGF, PlGF and sFlt-1 in pregnant women with SLE and active disease, inactive disease or preeclampsia.

38 women with SLE (according to American College of Rheumatology classification criteria) followed at a high risk prenatal care were included. They had no other autoimmune disease diagnosed and were divided according to disease activity and presence of PE. Blood collection was performed at third trimester of pregnancy, within 3 weeks of delivery, and frozen for subsequent blinded analysis through ELISA method.

According to according to SLEPDAI (Systemic Lupus Erythematosus Pregnancy Disease Activity Index), 23 patients had inactive SLE (group 1),8 had active lupus nephritis (group2) and 7 had PE (group3). The mean gestational age of blood collection was 36.4 weeks for group 1, 35.5 for group 2 and 35.8 for group 3, without statistical difference between groups. The mean values of VEGF, PlGF and sFlt-1 of all groups are described on Table 1. Considering VEGF and PlGF, patients with SLE and PE had significantly lower mean serum levels than SLE patients without PE, while sFlt-1 was significantly higher in patients with PE compared to inactive SLE and SLE nephritis. The ratio sFlt-1/PlGF was also significantly higher in patients of group 3(PE) compared to other patients with SLE (groups1 and 2). There was no difference between all three studied cytocines or sFlt-1/PlGF ratio when the results were compared between inactive and active SLE.

In this pilot study, pregnant patients with SLE and PE had lower mean serum levels of VEGF and PlGF and higher mean serum levels of sFlt-1 and sFlt-1/PlGF ratio than pregnant patients with inactive SLE and active SLE nephritis. The results suggest that SLE patients with PE have the same angiogenic and antiangiogenic profile of patients with PE without lupus. Further studies with more patients are needed to confirm the use of angiogenic and antiangiogenic factors as potential tools to differentiate PE from SLE nephritis in clinical practice.