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Markedly higher sFlt‐1/PlGF ratio in a woman with acute fatty liver of pregnancy compared with HELLP syndrome
Author(s) -
Suzuki Hirotada,
Nagayama Shiho,
Hirashima Chikako,
Takahashi Kayo,
Takahashi Hironori,
Ogoyama Manabu,
Nagayama Manabu,
Shirasuna Koumei,
Matsubara Shigeki,
Ohkuchi Akihide
Publication year - 2019
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.13786
Subject(s) - hellp syndrome , medicine , soluble fms like tyrosine kinase 1 , placental growth factor , gastroenterology , pregnancy , endocrinology , obstetrics , preeclampsia , vascular endothelial growth factor , vegf receptors , genetics , biology
Aim To compare serum levels of angiogenesis‐related factors between 14 women with HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome and a woman with acute fatty liver of pregnancy (AFLP). Methods Serum samples were collected in 2004–2008 and 2013–2016. The levels of soluble fms‐like tyrosine kinase 1 (sFlt‐1) and placental growth factor (PlGF) were measured by an automated electrochemiluminescence immunoassay using Elecsys sFlt‐1 and Elecsys PlGF. After logarithmic transformation, levels of sFlt‐1, PlGF and the sFlt‐1/PlGF ratio in a woman with AFLP were compared with those in women with HELLP syndrome, using the one‐sample t ‐test. Results At 37 weeks of gestation, a patient was diagnosed with AFLP based on Swansea criteria (showing six features including elevated transaminases), and she also showed a duodenal ulcer with active bleeding, thrombocytopenia and hypertension. Her serum levels of sFlt‐1 and sFlt‐1/PlGF ratio were significantly higher than in those with HELLP syndrome (273 040 pg/mL vs 15 135 [mean], P < 0.001; 4236 vs 224, P < 0.001; respectively). However, her serum level of PlGF was not significantly different from those with HELLP syndrome. Conclusion Serum levels of sFlt‐1 and the sFlt‐1/PlGF ratio, but not PlGF, in a woman with AFLP were markedly higher than those in women with HELLP syndrome. AFLP may be a different clinical entity from HELLP syndrome based on angiogenesis‐related factors. Clinically, the sFlt‐1/PlGF ratio may be used to rapidly distinguish AFLP from HELLP syndrome.