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1
المؤلفون: Ritsinger, V., Brismar, K., Mellbin, L., Näsman, Per, Rydén, L., Söderberg, S., Norhammar, A.
المصدر: Diabetes & Vascular Disease Research. 15(5):387-395
مصطلحات موضوعية: abnormal glucose tolerance, Acute myocardial infarction, insulin-like growth factor-binding protein 1, prognosis, glucose, hemoglobin A1c, insulin, lipid, proinsulin, somatomedin binding protein 1, somatomedin C, biological marker, IGFBP1 protein, human, acute heart infarction, adult, aged, all cause mortality, Article, body mass, cancer mortality, cardiovascular mortality, cerebrovascular accident, cohort analysis, controlled study, disease severity, fasting, female, follow up, glucose blood level, glucose tolerance, heart failure, hospital admission, insulin blood level, lipid blood level, long term care, major clinical study, male, outcome assessment, protein blood level, blood, cause of death, chi square distribution, disease exacerbation, heart infarction, Kaplan Meier method, metabolism, middle aged, mortality, neoplasm, proportional hazards model, risk factor, time factor, upregulation, Biomarkers, Blood Glucose, Chi-Square Distribution, Disease Progression, Follow-Up Studies, Humans, Insulin-Like Growth Factor Binding Protein 1, Kaplan-Meier Estimate, Myocardial Infarction, Neoplasms, Proportional Hazards Models, Risk Factors, Time Factors, Up-Regulation
الوصف: Objective: To investigate the long-term prognostic value of insulin-like growth factor-binding protein 1 in patients with acute myocardial infarction. Methods: Patients (n = 180) with admission glucose < 11 mmol/L without previously known diabetes admitted for an acute myocardial infarction in 1998–2000 were followed for mortality and cardiovascular events (first of cardiovascular mortality/acute myocardial infarction/stroke/severe heart failure) until the end of 2011 (median 11.6 years). Fasting levels of insulin-like growth factor-binding protein 1 at day 2 were related to outcome in Cox proportional hazard regression analyses. Results: Median age was 64 years, 69% were male and median insulin-like growth factor-binding protein 1 was 20 µg/L. Total mortality was 34% (n = 61) and 44% (n = 80) experienced a cardiovascular event during a median follow-up time of 11.6 years. After age adjustment, insulin-like growth factor-binding protein 1 was associated with all-cause (1.40; 1.02–1.93, p = 0.039) and cancer mortality (2.09; 1.15–3.79, p = 0.015) but not with cardiovascular death (p = 0.29) or cardiovascular events (p = 0.57). After adjustments also for previous myocardial infarction, previous heart failure and body mass index, insulin-like growth factor-binding protein 1 was still associated with all-cause mortality (1.38; 1.01–1.89, p = 0.046). Conclusion: In patients with acute myocardial infarction without previously known diabetes, high insulin-like growth factor-binding protein 1 was associated with long-term all-cause and cancer mortality but not with cardiovascular events.
وصف الملف: print
الوصول الحر: https://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-236723Test
https://doi.org/10.1177/1479164118781892Test -
2دورية أكاديمية
مصطلحات موضوعية: Foetal Development and Medicine, Obstetrics and Gynaecology, cervical length measurement, IGFBP1 protein, human, PAMG-1 protein, Premature birth, Term birth
الوصف: Background : Presence of placental a microglobulin-1 (PAMG-1) in cervicovaginal fluid is a bedside test to predict preterm delivery. Objective: To determine whether the accuracy of a positive PAMG-1 test result to predict preterm birth within 7 days and 14 days in our hospital setting can be improved by adding cervical length. Methods: We recruited 180 pregnant women who attended the labor ward of Siriraj Hospital, Thailand, from 2016 to 2018 for this prospective observational study of diagnostic accuracy. We used data from 161 women who met inclusion criteria including symptoms of preterm labor between 20 0/7 and 36 6/7 weeks’ gestation without ruptured membranes and with cervical dilatation <3 cm and effacement <80%. Presence of PAMG-1 in cervicovaginal fluid was tested using a PartoSure kit, cervical length was measured by transvaginal ultrasound, and the time to spontaneous delivery was calculated. Results: Pregnant women with labor pain who had cervical length <30 mm (45/161; 28%) went into delivery within 7 days, and women with a cervical length <15 mm (11/14; 79%) went into delivery within 7 days. When the PAMG-1 test result was positive and cervical length was ≤15 mm, the positive predictive value (PPV) was 83%; and when cervical length was £30 mm the PPV was 69%. The optimal cut off from receiver operating characteristic curve analysis showed that a cervical length <25 mm and PAMG-1 positive result has a PPV of 80% to predict preterm birth within 7 days and 90% within 14 days. The area under the curve (95% confidence interval) for a positive PAMG-1 result and cervical length cervical length ≤25 mm to predict preterm birth <7 days was 0.61 (0.50, 0.73) and <14 days was 0.60 (0.49, 0.70). Conclusions: Cervical length ranging 15–30 mm combined with a positive PAMG-1 test result has a high accuracy to predict imminent spontaneous delivery within 7 days by women with preterm labor and cervical dilatation <3 cm in clinical practice. PASW Statistics for Windows (version 18.0; ...
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3
المساهمون: UAM. Departamento de Cirugía
المصدر: Scientific Reports, Vol 11, Iss 1, Pp 1-13 (2021)
Scientific Reports
Biblos-e Archivo. Repositorio Institucional de la UAM
instnameمصطلحات موضوعية: 0301 basic medicine, Male, Reoperation, medicine.medical_specialty, Cell biology, Osteolysis, Medicina, Arthroplasty, Replacement, Hip, Science, Aseptic loosening, somatomedin binding protein 1, Periprosthetic, IGFBP1 protein, human, Diseases, Enzyme-Linked Immunosorbent Assay, In Vitro Techniques, Gastroenterology, Article, Elevated serum, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, Humans, In patient, titanium, Aged, 030222 orthopedics, Multidisciplinary, Osteoblasts, biology, business.industry, Macrophages, medicine.disease, Prosthesis Failure, Insulin-Like Growth Factor Binding Protein 1, Hip arthroplasty, 030104 developmental biology, biology.protein, Female, Hip Prosthesis, Antibody, business, Biomarkers, Total hip arthroplasty
الوصف: The biological mechanisms involved in aseptic loosening include inflammation-associated and bone resorption-associated processes. Coordinated cellular actions result in biochemical imbalances with devastating consequences for the joint. Given that this condition is not known for showing systemic signs, we investigated whether circulating levels of inflammation-related proteins are altered in patients with aseptic loosening. Our study included 37 patients who underwent revision surgery due to hip osteolysis and aseptic loosening and 31 patients who underwent primary total hip arthroplasty. Using antibody arrays, we evaluated the serum levels of 320 proteins in four patients from each group. The results showed differences in insulin-like growth factor-binding protein 1 (IGFBP-1) concentrations, which we then quantified using enzyme-linked immunosorbent assay tests in all study patients. The results confirmed that serum IGFBP-1 concentrations were higher in the revision surgery patients than in the hip arthroplasty patients. In vitro studies showed that exposure of human osteoblasts to titanium particles induced an IGFBP-1 release that further increased when exposure to particles was performed in media conditioned by human M1 macrophages. These findings suggest that elevated serum IGFBP-1 levels in patients with aseptic loosening can arise from increased local IGFBP-1 production in the inflammatory environment of the periprosthetic bed.
This work was supported by Grant RTI2018-095159-B-I00 from the Spanish Ministry of Science, Innovation and Universities (MCINN) and Grant PI18/00643 from Instituto de Salud Carlos III (ISCIII)-Fondo Europeo de Desarrollo Regional (FEDER) and the Spanish Ministry of Economy and Competitiveness (MINECO-AES). LS is supported by a Miguel Servet contract from ISCIII-MINECO-AES-FEDER-FSE. NV is supported by Program I2 from the Regional Government of Madrid. The authors are indebted to Fatima Bensiamar (IdiPAZ and CIBER-BBN) for her excellent technical assistance with the cell culture experiments and gene expression analysis and to the Cell Culture Core Facilities of IdiPAZ.وصف الملف: application/pdf
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4a18f50d25232d779a03a6ffd0ec8d2aTest
https://doi.org/10.1038/s41598-020-79813-xTest -
4رسالة جامعية
المؤلفون: Rolnik, Daniel Lorber
مرشدي الرسالة: Francisco, Rossana Pulcineli Vieira
مصطلحات موضوعية: Biological markers, Cervical length measurement, Cervix uteri/secretion, Cervix uteri/ultrasonography, Colo do útero/secreção, Colo do útero/ultrassonografia, Curva ROC, Gestational age, Gravidez, Idade gestacional, IGFBP1 protein human, IGFBP1 proteína humana, Insulin-like growth factor binding protein 1, Marcadores biológicos, Medição de risco/métodos, Medida do comprimento cervical, Nascimento prematuro/diagnóstico, Nascimento prematuro/ultrassonografia, Predictive value of tests, Pregnancy trimester third, Pregnancy, Pregnancy outcome, Pregnancy trimester second, Premature birth/diagnosis, Premature birth/ultrasonography, Proteína 1 de ligação a fator de crescimento insulin-like, Resultado da gravidez, Risk assessment/methods, ROC curve, Segundo trimestre da gravidez, Terceiro trimestre da gravidez, Valor preditivo dos testes
الوصف: INTRODUÇÃO: O antecedente de parto prematuro espontâneo em gestação anterior é considerado o principal e mais importante fator de risco clínico para prematuridade, principal causa de morbidade e mortalidade neonatal. Cerca de 25% das pacientes que tiveram parto prematuro apresentarão recorrência. A prevenção secundária consiste na pesquisa de marcadores de maior risco, com o intuito de instituir medidas terapêuticas apropriadas e de evitar tratamentos desnecessários. A hipótese do presente estudo é a de que existe correlação entre os resultados da avaliação do colo uterino e do teste para proteína-1 fosforilada ligada ao fator de crescimento insulina-símile (phIGFBP-1) e que a utilização de ambos em associação possa predizer a ocorrência de parto prematuro com maior sensibilidade. OBJETIVOS: Averiguar a utilidade da medida do comprimento do colo uterino e do teste para phIGFBP-1 na predição do parto prematuro antes de 37 e de 34 semanas, a existência de relação dos testes entre si, o melhor valor de corte da medida do colo em diferentes idades gestacionais e a melhor época de realização de cada um dos exames. MÉTODO: Foram compilados e submetidos a análise secundária os dados de 101 gestantes com antecedente de parto prematuro atendidas no Setor de Baixo Peso Fetal da Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre 2003 e 2008. A medida do comprimento cervical e o teste para phIGFBP-1 foram realizados a cada três semanas, entre 24 e 34 semanas de gestação, e comparados com o desfecho de parto prematuro e nascimento com 34 semanas ou menos, e o melhor valor de corte do colo uterino foi estabelecido por meio de curva de características operacionais. RESULTADOS: Das 101 gestações estudadas, 25 (24,8%) terminaram em parto prematuro, das quais 12 (11,9%) ocorreram com 34 semanas ou menos. As idades gestacionais médias de avaliação foram de 24, 27, 30 e 33 semanas, e os valores de corte do colo uterino foram de 22, 21, 20 e 16 mm, respectivamente. A medida do comprimento do colo apresentou maior sensibilidade (cerca de 70%) e foi capaz de predizer o parto prematuro em todas as avaliações. O teste para phIGFBP-1 não foi útil com 24 semanas, porém foi capaz de detectar de forma independente o risco de prematuridade com 27, com 30 e com 33 semanas. Houve associação estatística dos exames entre si, de forma que o comprimento cervical médio foi menor em gestantes com teste positivo para phIGFBP-1. A associação dos exames elevou a sensibilidade e o valor preditivo negativo de forma significativa. CONCLUSÕES: A medida do comprimento do colo pela ultrassonografia transvaginal constitui bom marcador de risco para parto prematuro com 24 semanas, e o teste para phIGFBP-1 é útil após 27 semanas. A associação dos dois exames possui alta sensibilidade e alto valor preditivo negativo em gestantes de alto risco para prematuridade espontânea, e a realização do primeiro com 24 semanas e do segundo com 27 semanas constitui bom modelo preditivo para o parto prematuro
INTRODUCTION: The history of spontaneous preterm birth in a previous pregnancy is considered the main and most important clinical risk factor for preterm birth, the leading cause of neonatal morbidity and mortality. About 25% of these patients will deliver prematurely again. Secondary prevention consists in the search for markers of increased risk, in order to institute appropriate therapeutic actions and to avoid unnecessary treatments. The hypothesis of this study is that there is a correlation between the results of the evaluation of the cervix and the test for phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) and that the use of both in combination can predict the occurrence of preterm delivery with higher sensitivity. OBJECTIVES: To investigate the usefulness of the measurement of the cervical length and phIGFBP-1 rapid test in the prediction of preterm birth before 37 and 34 weeks, the existence of a relationship between the tests themselves, the best cutoff value of cervical length measurement at different gestational ages and the best time to carry out each of the exams. METHODS: Data of 101 women with previous preterm birth assisted at the Obstetrical Clinic of the Hospital das Clínicas, Faculty of Medicine, University of São Paulo between 2003 and 2008 were collected and subjected to secondary analysis. The measurement of cervical length and the phIGFBP-1 test were performed every three weeks, between 24 and 34 weeks gestation, and compared with the outcome of premature birth before 37 and 34 weeks, and the best cutoff value of the cervix was determined by receiver operator characteristic curves. RESULTS: Of the 101 pregnancies studied, 25 (24.8%) ended in preterm birth, of which 12 (11.9%) occurred at 34 weeks or less. The mean gestational age in each evaluation was 24, 27, 30 and 33 weeks, and the cutoff of the cervix were 22, 21, 20 and 16 millimeters, respectively. The measurement of cervical length showed the highest sensitivity (approximately 70%) and was able to predict preterm birth in all evaluations. The phIGFBP-1 test was not useful at 24 weeks, but was able to independently detect the risk of prematurity at 27, 30 and 33 weeks. Statistical association between the exams was observed, so that the mean cervical length was lower in pregnant women testing positive for phIGFBP-1. The combination of both tests significantly increased the sensitivity and negative predictive value. CONCLUSIONS: The measurement of cervical length by transvaginal ultrasound is a good marker of risk for preterm delivery at 24 weeks, and the test for phIGFBP-1 is useful after 27 weeks. The association of the two tests is valuable and shows high sensitivity and high negative predictive value in women at high risk for spontaneous preterm birth, when the first is preformed with 24 weeks, and the second with 27 weeksوصف الملف: application/pdf
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5دورية أكاديمية
المساهمون: DUKE-NUS MEDICAL SCHOOL
المصدر: Unpaywall 20201031
مصطلحات موضوعية: angiopoietin, angiopoietin like protein 3, somatomedin binding protein 1, somatomedin binding protein 2, stem cell factor, thrombopoietin, unclassified drug, ANGPTL3 protein, human, IGF2 protein, IGFBP-2 protein, IGFBP1 protein, somatomedin B, animal cell, animal experiment, animal model, article, bone marrow, controlled study, correlation analysis, cryopreservation, dilution, ex vivo study, hematopoiesis, hematopoietic stem cell, human cell, in vivo study, mesenchymal stroma cell, mononuclear cell, mouse
الوصف: 10.1186/scrt460 ; Stem Cell Research and Therapy ; 5 ; 3 ; 71
العلاقة: Fan, X, Gay, F.P, Lim, F.W, Ang, J.M, Chu, P.P, Bari, S, Hwang, W.Y (2014). Low-dose insulin-like growth factor binding proteins 1 and 2 and angiopoietin-like protein 3 coordinately stimulate ex vivo expansion of human umbilical cord blood hematopoietic stem cells as assayed in NOD/SCID gamma null mice. Stem Cell Research and Therapy 5 (3) : 71. ScholarBank@NUS Repository. https://doi.org/10.1186/scrt460Test; https://scholarbank.nus.edu.sg/handle/10635/181754Test
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6تقرير
المؤلفون: Li, Heng-Hong, Doiron, Kathryn, Patterson, Andrew D, Gonzalez, Frank J, Fornace Jr, Albert J
مصطلحات موضوعية: Alcohol-induced liver disease, Transcriptomics, Biomarker, Igfbp1, IGFBP1 protein
الوصف: Background Alcohol consumption is a major cause of liver disease in humans. The use and monitoring of biomarkers associated with early, pre-clinical stages of alcohol-induced liver disease (pre-ALD) could facilitate diagnosis and treatment, leading to improved outcomes. Methods We investigated the pathological, transcriptomic and protein changes in early stages of pre-ALD in mice fed the Lieber-Decarli liquid diet with or without alcohol for four months to identify biomarkers for the early stage of alcohol induced liver injury. Mice were sampled after 1, 2 and 4 months treatment. Results Pathological examination revealed a modest increase in fatty liver changes in alcohol-treated mice. Transcriptomics revealed gene alterations at all time points. Most notably, the Igfbp1 (Insulin-Like Growth Factor Binding Protein 1) was selected as the best candidate gene for early detection of liver damage since it showed early and continuously enhanced induction during the treatment course. Consistent with the microarray data, both Igfbp1 mRNA expression in the liver tissue and the IGFBP1 serum protein levels showed progressive and significant increases over the course of pre-ALD development. Conclusions The results suggest that in conjunction with other tests, serum IGFBPI protein could provide an easily measured biomarker for early detection of alcohol-induced liver injury in humans.
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7دورية أكاديمية
المؤلفون: DI FABRIZIO, LAURA, Irene GIARDINA, Irene CETIN, Mariarosaria DI TOMMASO, CIAVATTINI, ANDREA, Mariavittoria LOCCI, Fabio FACCHINETTI, Marina ZONCA, Gian Carlo DI RENZO
المساهمون: DI FABRIZIO, Laura, Giardina, Irene, Irene, Cetin, Mariarosaria DI TOMMASO, Ciavattini, Andrea, Mariavittoria, Locci, Fabio, Facchinetti, Marina, Zonca, DI RENZO, Giancarlo
مصطلحات موضوعية: Cervical length measurement, Human IGFBP1 protein, Premature birth, Premature obstetric labor
الوصف: BACKGROUND: The aim of this study was to assess the efficacy of PAMG-1 test (placental alpha microglobulin-1) in cervicovaginal secretions collected immediately following transvaginal ultrasound (TVUS) of women with signs and symptoms of preterm labor (PTL), clinically intact membranes and cervical length between 15 and 30 mm for the prediction of imminent spontaneous delivery (within 7 days of testing), as well as delivery <34 weeks of gestation.METHODS: Performing PAMG-1 test in 79 women with singleton pregnancy (24(0/7)-33(6/7) weeks' gestation) reporting signs and symptoms indicative of IPTI, and cervical length <30 mm.RESULTS: For PTB prediction risk within 7 days of testing in pregnant women with cervicale length between 15-30 mm sensitivity is 100% and specificity is 94%. Positive predictive value (PPV) is 77% and negative predictive value (NPV) is 100%. For delivery prediction <34 weeks of gestation sensitivity decreased from 100% to 67% and specificity from 94% to 89%, PPV is 55% and NPV 93%.CONCLUSIONS: The inaccuracy of traditional methods, including biophysical tests, biochemical markers, or the combination of both, for assessing the risk of spontaneous pretenn birth in patients presenting with symptoms of PTL often leads to unnecessary admission and administration of corticosteroids and tocolytics. The PAMG-1 test demonstrated high efficacy in identifying women at risk of imminent PTL within 7 days of testing, despite being performed immediately after TVUS. High NPV can prevent improper admission and unnecessary therapies for mother and fetus.
وصف الملف: STAMPA
العلاقة: info:eu-repo/semantics/altIdentifier/pmid/29856188; info:eu-repo/semantics/altIdentifier/wos/WOS:000456056700012; volume:70; issue:5; firstpage:635; lastpage:640; numberofpages:6; journal:MINERVA GINECOLOGICA; http://hdl.handle.net/11391/1438058Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85051645688; https://www.minervamedica.it/en/getpdf/iQp4Gh5SecPvAdJFmHgntEIQxAsYRpUi4ifFTMxBSnnvNSoegOvAonw5FJkLf7tJOIUlXK8Gn78L%252FMV21AA9VA%253D%253D/R09Y2018N05A0635.pdfTest
الإتاحة: https://doi.org/10.23736/S0026-4784.18.04243-0Test
http://hdl.handle.net/11391/1438058Test
https://www.minervamedica.it/en/getpdf/iQp4Gh5SecPvAdJFmHgntEIQxAsYRpUi4ifFTMxBSnnvNSoegOvAonw5FJkLf7tJOIUlXK8Gn78L%252FMV21AA9VA%253D%253D/R09Y2018N05A0635.pdfTest -
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المؤلفون: Di Fabrizio L., Giardina I., Cetin I., Di Tommaso M., Ciavattini A., Locci M., Facchinetti F., Zonca M., Di Renzo G. C.
المساهمون: Di Fabrizio, L., Giardina, I., Cetin, I., Di Tommaso, M., Ciavattini, A., Locci, M., Facchinetti, F., Zonca, M., Di Renzo, G. C.
مصطلحات موضوعية: Adult, Cervical length measurement, Human IGFBP1 protein, Adolescent, Placenta, Gestational Age, Predictive Value of Test, Sensitivity and Specificity, Ultrasonography, Prenatal, Prospective Studie, Young Adult, Obstetric Labor, Premature, Alpha-Globulin, Pregnancy, Premature obstetric labor, Premature Birth, Female, Human
الوصف: BACKGROUND: The aim of this study was to assess the efficacy of PAMG-1 test (placental alpha microglobulin-1) in cervicovaginal secretions collected immediately following transvaginal ultrasound (TVUS) of women with signs and symptoms of preterm labor (PTL), clinically intact membranes and cervical length between 15 and 30 mm for the prediction of imminent spontaneous delivery (within 7 days of testing), as well as delivery
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=od______3730::1d4b08400f8192e3ebf01476464a1722Test
http://hdl.handle.net/11588/895536Test -
9رسالة جامعية
المؤلفون: Daniel Lorber Rolnik
مرشدي الرسالة: Rossana Pulcineli Vieira Francisco
المصدر: Biblioteca Digital de Teses e Dissertações da USPUniversidade de São PauloUSP.
مصطلحات موضوعية: Colo do útero/secreção, Colo do útero/ultrassonografia, Curva ROC, Gravidez, Idade gestacional, IGFBP1 proteína humana, Marcadores biológicos, Medição de risco/métodos, Medida do comprimento cervical, Nascimento prematuro/diagnóstico, Nascimento prematuro/ultrassonografia, Proteína 1 de ligação a fator de crescimento insulin-like, Resultado da gravidez, Segundo trimestre da gravidez, Terceiro trimestre da gravidez, Valor preditivo dos testes, Biological markers, Cervical length measurement, Cervix uteri/secretion, Cervix uteri/ultrasonography, Gestational age, IGFBP1 protein human, Insulin-like growth factor binding protein 1, Predictive value of tests, Pregnancy trimester third, Pregnancy, Pregnancy outcome, Pregnancy trimester second, Premature birth/diagnosis, Premature birth/ultrasonography, Risk assessment/methods, ROC curve
الوصف: INTRODUÇÃO: O antecedente de parto prematuro espontâneo em gestação anterior é considerado o principal e mais importante fator de risco clínico para prematuridade, principal causa de morbidade e mortalidade neonatal. Cerca de 25% das pacientes que tiveram parto prematuro apresentarão recorrência. A prevenção secundária consiste na pesquisa de marcadores de maior risco, com o intuito de instituir medidas terapêuticas apropriadas e de evitar tratamentos desnecessários. A hipótese do presente estudo é a de que existe correlação entre os resultados da avaliação do colo uterino e do teste para proteína-1 fosforilada ligada ao fator de crescimento insulina-símile (phIGFBP-1) e que a utilização de ambos em associação possa predizer a ocorrência de parto prematuro com maior sensibilidade. OBJETIVOS: Averiguar a utilidade da medida do comprimento do colo uterino e do teste para phIGFBP-1 na predição do parto prematuro antes de 37 e de 34 semanas, a existência de relação dos testes entre si, o melhor valor de corte da medida do colo em diferentes idades gestacionais e a melhor época de realização de cada um dos exames. MÉTODO: Foram compilados e submetidos a análise secundária os dados de 101 gestantes com antecedente de parto prematuro atendidas no Setor de Baixo Peso Fetal da Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre 2003 e 2008. A medida do comprimento cervical e o teste para phIGFBP-1 foram realizados a cada três semanas, entre 24 e 34 semanas de gestação, e comparados com o desfecho de parto prematuro e nascimento com 34 semanas ou menos, e o melhor valor de corte do colo uterino foi estabelecido por meio de curva de características operacionais. RESULTADOS: Das 101 gestações estudadas, 25 (24,8%) terminaram em parto prematuro, das quais 12 (11,9%) ocorreram com 34 semanas ou menos. As idades gestacionais médias de avaliação foram de 24, 27, 30 e 33 semanas, e os valores de corte do colo uterino foram de 22, 21, 20 e 16 mm, respectivamente. A medida do comprimento do colo apresentou maior sensibilidade (cerca de 70%) e foi capaz de predizer o parto prematuro em todas as avaliações. O teste para phIGFBP-1 não foi útil com 24 semanas, porém foi capaz de detectar de forma independente o risco de prematuridade com 27, com 30 e com 33 semanas. Houve associação estatística dos exames entre si, de forma que o comprimento cervical médio foi menor em gestantes com teste positivo para phIGFBP-1. A associação dos exames elevou a sensibilidade e o valor preditivo negativo de forma significativa. CONCLUSÕES: A medida do comprimento do colo pela ultrassonografia transvaginal constitui bom marcador de risco para parto prematuro com 24 semanas, e o teste para phIGFBP-1 é útil após 27 semanas. A associação dos dois exames possui alta sensibilidade e alto valor preditivo negativo em gestantes de alto risco para prematuridade espontânea, e a realização do primeiro com 24 semanas e do segundo com 27 semanas constitui bom modelo preditivo para o parto prematuro
INTRODUCTION: The history of spontaneous preterm birth in a previous pregnancy is considered the main and most important clinical risk factor for preterm birth, the leading cause of neonatal morbidity and mortality. About 25% of these patients will deliver prematurely again. Secondary prevention consists in the search for markers of increased risk, in order to institute appropriate therapeutic actions and to avoid unnecessary treatments. The hypothesis of this study is that there is a correlation between the results of the evaluation of the cervix and the test for phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) and that the use of both in combination can predict the occurrence of preterm delivery with higher sensitivity. OBJECTIVES: To investigate the usefulness of the measurement of the cervical length and phIGFBP-1 rapid test in the prediction of preterm birth before 37 and 34 weeks, the existence of a relationship between the tests themselves, the best cutoff value of cervical length measurement at different gestational ages and the best time to carry out each of the exams. METHODS: Data of 101 women with previous preterm birth assisted at the Obstetrical Clinic of the Hospital das Clínicas, Faculty of Medicine, University of São Paulo between 2003 and 2008 were collected and subjected to secondary analysis. The measurement of cervical length and the phIGFBP-1 test were performed every three weeks, between 24 and 34 weeks gestation, and compared with the outcome of premature birth before 37 and 34 weeks, and the best cutoff value of the cervix was determined by receiver operator characteristic curves. RESULTS: Of the 101 pregnancies studied, 25 (24.8%) ended in preterm birth, of which 12 (11.9%) occurred at 34 weeks or less. The mean gestational age in each evaluation was 24, 27, 30 and 33 weeks, and the cutoff of the cervix were 22, 21, 20 and 16 millimeters, respectively. The measurement of cervical length showed the highest sensitivity (approximately 70%) and was able to predict preterm birth in all evaluations. The phIGFBP-1 test was not useful at 24 weeks, but was able to independently detect the risk of prematurity at 27, 30 and 33 weeks. Statistical association between the exams was observed, so that the mean cervical length was lower in pregnant women testing positive for phIGFBP-1. The combination of both tests significantly increased the sensitivity and negative predictive value. CONCLUSIONS: The measurement of cervical length by transvaginal ultrasound is a good marker of risk for preterm delivery at 24 weeks, and the test for phIGFBP-1 is useful after 27 weeks. The association of the two tests is valuable and shows high sensitivity and high negative predictive value in women at high risk for spontaneous preterm birth, when the first is preformed with 24 weeks, and the second with 27 weeks -
10رسالة جامعية
المؤلفون: Rolnik, Daniel Lorber
المساهمون: Francisco, Rossana Pulcineli Vieira
مصطلحات موضوعية: Biological markers, Cervical length measurement, Cervix uteri/secretion, Cervix uteri/ultrasonography, Colo do útero/secreção, Colo do útero/ultrassonografia, Curva ROC, Gestational age, Gravidez, Idade gestacional, IGFBP1 protein human, IGFBP1 proteína humana, Insulin-like growth factor binding protein 1, Marcadores biológicos, Medição de risco/métodos, Medida do comprimento cervical, Nascimento prematuro/diagnóstico, Nascimento prematuro/ultrassonografia, Predictive value of tests, Pregnancy trimester third, Pregnancy, Pregnancy outcome, Pregnancy trimester second, Premature birth/diagnosis, Premature birth/ultrasonography, Proteína 1 de ligação a fator de crescimento insulin-like, Resultado da gravidez, Risk assessment/methods, ROC curve, Segundo trimestre da gravidez
الوصف: INTRODUÇÃO: O antecedente de parto prematuro espontâneo em gestação anterior é considerado o principal e mais importante fator de risco clínico para prematuridade, principal causa de morbidade e mortalidade neonatal. Cerca de 25% das pacientes que tiveram parto prematuro apresentarão recorrência. A prevenção secundária consiste na pesquisa de marcadores de maior risco, com o intuito de instituir medidas terapêuticas apropriadas e de evitar tratamentos desnecessários. A hipótese do presente estudo é a de que existe correlação entre os resultados da avaliação do colo uterino e do teste para proteína-1 fosforilada ligada ao fator de crescimento insulina-símile (phIGFBP-1) e que a utilização de ambos em associação possa predizer a ocorrência de parto prematuro com maior sensibilidade. OBJETIVOS: Averiguar a utilidade da medida do comprimento do colo uterino e do teste para phIGFBP-1 na predição do parto prematuro antes de 37 e de 34 semanas, a existência de relação dos testes entre si, o melhor valor de corte da medida do colo em diferentes idades gestacionais e a melhor época de realização de cada um dos exames. MÉTODO: Foram compilados e submetidos a análise secundária os dados de 101 gestantes com antecedente de parto prematuro atendidas no Setor de Baixo Peso Fetal da Clínica Obstétrica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre 2003 e 2008. A medida do comprimento cervical e o teste para phIGFBP-1 foram realizados a cada três semanas, entre 24 e 34 semanas de gestação, e comparados com o desfecho de parto prematuro e nascimento com 34 semanas ou menos, e o melhor valor de corte do colo uterino foi estabelecido por meio de curva de características operacionais. RESULTADOS: Das 101 gestações estudadas, 25 (24,8%) terminaram em parto prematuro, das quais 12 (11,9%) ocorreram com 34 semanas ou menos. As idades gestacionais médias de avaliação foram de 24, 27, 30 e 33 semanas, e os valores de corte do colo uterino foram de 22, 21, 20 e 16 mm, respectivamente. A medida do ...
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