Diagnóstico prenatal del retraso de crecimiento intrauterino mediante marcadores bioquímicos

Gómeza, M.D.; Ferrero, S.; Valls, C.; Ponce, J.; Miró, E.; Borrás, M.; Laïlla, J.M.

doi:10.1016/S0304-5013(04)75991-9

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Bibliografía

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Resumen

Objetivo

Determinar la relación y capacidad diagnóstica de la IGF-I (insulin-like growth factor I), IGFBP-I (insulin-like growth factor binding protein I), leptina, y alfa-fetoproteína (AFP) en líquido amniótico de 14-18 semanas con el desajuste ponderal del feto al nacer.

Sujetos y métodos

Estudio longitudinal y prospectivo. Gestantes con amniocentesis de 14-18 semanas. 86 controles, 18 RCIU (retraso de crecimiento intrauterino) < percentil 10, y 17 RCIU < percentil 5.

Resultados

No se demuestra una correlación significativa entre el RCIU y la IGF-I, la IGFBP-I, y la leptina. La AFP cumple una correlación inversa con la severidad del RCIU; en el RCIU < percentil 10 presentó: sensibilidad (S), 65,7%; especificidad (E), 56,9%; valor predictivo positivo (VPP), 38,3%; valor predictivo negativo (VPN), 80,3%, y una capacidad global del 65,6%. En el RCIU < percentil 5 se obtuvo: S, 76,4%; E, 54,8%; VPP, 21,6%; VPN, 93,4%, y una capacidad global del 70,6%. Conclusión: Los valores elevados de AFP en líquido amniótico de diagnóstico prenatal pueden contribuir a la detección precoz de la población con riesgo de desarrollar un RCIU.

Palabras clave:

Retraso de crecimiento intrauterino

Insulin-like growth factor I

Insulin-like growth factor binding protein I

Leptina

Alfa-fetoproteína

Abstract

Objective

To determine the relationship between intrauterine growth retardation (IUGR) and insulinlike growth factor-1 (IGF-I), IGF binding protein-1 (IGFBP-I), leptin, and alfa-fetoprotein (AFP) levels in amniotic fluid after 14-18 weeks of gestation, and to assess the diagnostic utility of these biochemical markers.

Subjects and methods

We performed a longitudinal, prospective study. Amniocentesis was performed in pregnant women after 14-18 weeks of gestation. The study population consisted of 86 controls, 18 IUGR<10 percentile, and 17 IUGR<5 percentile.

Results

No significant correlation was found between the severity of IUGR and IGF-I, IGFBP-I, or leptin. AFP was inversely correlated with the severity of IUGR; the results for IUGR<10 percentile were: sensitivity: 65.7%, specificity: 56.9%, positive predictive value: 38.3%, negative predictive value: 80.3%, and an overall diagnostic capacity of 65.6%. The results for the IUGR<5 percentile were: sensitivity: 76.4%, specificity: 54.8%, positive predictive value: 21.6%, negative predictive value: 93.4%, and an overall diagnostic capacity of 70.6%.

Conclusion

Elevated values of AFP in amniotic fluid may help in the early detection of populations at risk for IUGR.

Keywords:

Intrauterine growth retardation

Insulin-like growth factor I

Insulin-like growth factor binding protein I

Leptin

Alpha-fetoprotein

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