MicroARN: la biología molecular como herramienta de predicción en preeclampsia

Preeclampsia is a disease with a significant incidence worldwide that is directly associated with 15% of maternal deaths. This is usually characterized by the presence of hypertension and proteinuria, which manifests itself from the middle of pregnancy. MicroRNAs are single-stranded RNA molecules that act primarily by degrading transcribed messenger RNA or inhibiting microRNA translation. Placental microRNAs play a role in the growth and function of the placenta, their potential use as diagnostic biomarkers is considered feasible due to the ability to enter the maternal circulation and be detectable in maternal plasma.     

Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials

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Absence of relaxation to lactate in human placental vessels of pregnancies with severe preeclampsia

OBJECTIVE: Our objective was to determine whether the observed relaxation to lactate and other agents in placental vessels of normal pregnancies is altered in severe preeclampsia.STUDY DESIGN: Isolated placental arteries and veins from women with severe preeclampsia and uncomplicated term pregnancies were precontracted with prostaglandin F_2α under 5% oxygen and 5% carbon dioxide with the balance nitrogen (Po₂ 35 to 38 torr) and then exposed to lactate (1 to 10 mmol/L, pH 7.4, n = 8 to 15), arachidonic acid (0.01 to 10 μmol/L, n = 6 to 13), nitroglycerin (1 nmol to 1 μmol/L, n = 4 to 12), or forskolin (0.01 to 10 μmol/L, n = 6 to 9). The response to lactate was also examined in placental vessels from appropriate-for-gestational-age preterm deliveries (n = 8) for comparison with a similar group with severe preeclampsia (n = 8). The t test and analysis of variance statistics were used.RESULTS: Relaxation to lactate was markedly inhibited in both placental arteries and veins of women with severe preeclampsia compared with vessels from uncomplicated term or preterm pregnancies. Responses to the other relaxing agents were not altered in the severely preeclampsia vessels.CONCLUSIONS: In severe preeclampsia absence of lactate-induced dilatation of placental vessels may contribute to the fetal complications associated with impaired blood flow and vasospasm.     

可溶性细胞间粘附分子-1在妊娠期高血压疾病中的作用

目的:探讨可溶性细胞间粘附分子-1在妊娠期高血压疾病患者血浆中的变化,为临床诊治提供依据。方法:用ELISA法检测29例妊娠期高血压疾病患者血浆中可溶性细胞间粘附分子-1水平,并与正常妊娠组和正常对照组进行组间比较。结果:子痫前期组、妊娠期高血压组、正常妊娠组晚期及正常对照组的可溶性细胞间粘附分子-1水平分别为1129.82±399.16、794.35±255.57、661.51±301.79及549.23±139.98ng/ml。组间比较,子痫前期组与妊娠期高血压组之间P<0.05,与正常妊娠组晚期及正常对照组之间P<0.001;妊娠期高血压组与正常对照组之间P<0.001;妊娠期高血压组与正常妊娠组晚期相比P>0.05,正常妊娠组3个不同孕龄阶段P>0.05。结论:可溶性细胞间粘附分子-1在妊娠期高血压疾病时显著升高,并随病情的加重而增高,可作为该病诊断和监控的一项指标。     

Correlation of P-selectin and lipoprotein(a), and other lipid parameters in preeclampsia

Preeclampsia is a pregnancy specific disorder and is thought to be associated with generalized endothelial dysfunction. P-selectin, an adhesion molecule, mediates the interaction of monocytes, platelets, and endothelial cells. Increased P-selectin levels and altered lipid and lipoprotein metabolism were reported in preeclampsia and during pregnancy. In order to investigate the relationship between serum P-selectin and lipoprotein(a), and other lipid parameters, 28 preeclampsia [13 severe (group I) and 15 mild preeclampsia (group II), 15 healthy pregnant (group III) and 20 non-pregnant (group IV)] women were investigated. Serum P-selectin, lipoprotein(a), total cholesterol, triglyceride, and high density lipoprotein cholesterol were measured and low-density lipoprotein cholesterol was derived. Serum P-selectin concentrations were consistently and significantly higher in the severe preeclampsia group than in the mild preeclampsia, healthy pregnancy, and non-pregnant control groups (P<0.0001, for all). The mild preeclampsia group also had increased serum P-selectin concentrations compared with the healthy pregnancy group and non-pregnant controls (P<0.05 and P<0.0001, respectively). Serum P-selectin and lipoprotein(a) levels revealed a significant and linear increase with the severity of preeclampsia. There were also significant (in groups I and II) and borderline (in groups III and IV) correlations between P-selectin and total cholesterol. The present study suggests that P-selectin may be an additional risk marker for preeclampsia, and may be useful in distinguishing women with mild and severe preeclampsia and normal pregnancy. Received: 9 November 2001 / Accepted: 6 February 2002     

先兆子痫患者HLA-DQA1、-DQB1、-DPA1基因多态性

目的:探讨人类白细胞抗原HLA-DQ-A1、DQB1、DPA1基因多态性与先兆子痫发病的关系。方法:采用序列特异性引物技术(PCRSSP)对46例先兆子痫患者和105例正常孕妇及其新生儿进行HLA-DQ-DPA1等位基因分型。结果:所有标本共检出11种HLADQA1基因表型、16种HLADQB1基因表型、6种HLADPA1基因表型。先兆子痫患者HLA-DQ-B10301基因频率高于正常孕妇,差异有显著性(Pc=0.032,RR=2.43,AR=0.30),其余各基因表型频率两组比较差异均无显著性。结论:HLADQB10301基因可能是一种先兆子痫发病的易感基因。     

氧化修饰低密度脂蛋白在子痫前期中的测定及意义

目的测定氧化修饰低密度脂蛋白(oxLDL)在子痫前期中的变化,探讨其意义。方法采用酶联免疫吸附法(ELISA)测定子痫前期重度组、子痫前期轻度组及对照组血清oxLDL水平。结果(1)3组孕妇血清oxLDL比较,见子痫前期重度组升高(49.35±4.22)μg/d l,与对照组(31.71±3.51)μg/d l比较有显著差异(P<0.01);子痫前期轻度组(39.12±2.37)μg/d l升高,与对照组比较有显著差异(P<0.05);子痫前期重度组与轻度组比较无显著差异(P>0.05)。(2)子痫前期重度组血清oxLDL与收缩压、舒张压呈正相关(r=0.51,P<0.01;r=0.47,P<0.05)。结论研究提示oxLDL可能是子痫前期发病的重要因素。     

硝苯地平联合拉贝洛尔治疗对子痫前期患者sFlt–1及PLGF浓度的影响

目的：探讨硝苯地平联合拉贝洛尔治疗对子痫前期患者可溶性Fms样酪氨酸激酶–1(sFlt–1)及胎盘生长因子（PLGF）浓度的影响。方法：选择2021年4月至2022年4月于郑州大学第一附属医院诊治的380例子痫前期患者,根据简单随机法分成观察组、对照组,各190例。对照组患者给予硫酸镁联合硝苯地平治疗,观察组患者在对照组基础上联合拉贝洛尔治疗,比较两组患者治疗前、治疗14 d后血液/尿液指标[尿肌酐（UCr）、24 h尿蛋白定量（24h UPQ）、血清脑利尿钠肽（BNP）、sFlt–1、PLGF]、血压[收缩压（SBP）、舒张压（DBP）]、超声检查指标[血流阻力指数（RI）、脐动脉血流速度峰谷比（S/D）与搏动指数（PI）]以及妊娠结局。结果：观察组患者治疗后UCr、24h UPQ、血清BNP、s Flt–1水平、SBP、DBP、RI、PI、S/D均低于对照组,血清PLGF水平高于对照组,差异具有统计学意义（P <0.05）;观察组不良妊娠结局总发生率为13.16%,低于对照组的25.26%,差异具有统计学意义（P <0.05）。结论：子痫前期患者联合应用硝苯地平与拉贝洛...     

血清Toll样受体4联合超声血流指标与子痫前期围生儿结局的相关性

目的探讨血清Toll样受体4 (TLR4)联合超声血流指标与子痫前期围生儿结局的相关性。方法选择2017年2月-2019年6月在南充市中心医院住院分娩的子痫前期孕妇125例作为病例组,同期选择孕期健康和血压正常的孕妇125例作为对照组,所有入选者都给予超声血流检查,检测血清TLR4表达情况,调查病例组围生儿的结局并进行相关性分析。结果病例组孕妇大脑中动脉超声RI与PI值都显著高于对照组孕妇,血清TLR4值显著高于对照组孕妇,差异均有统计学意义(P<0.05)。所有围生儿都顺利分娩,病例组围生儿的1 min Apgar评分与5 min Apgar评分都显著低于对照组,差异有统计学意义(P<0.05)。在病例组中Pearson相关分析显示围生儿的5 min Apgar评分水平都与血清TLR4值及RI、PI呈现负相关性(P<0.05)。结论子痫前期患者表现为血清TLR4表达量上升与超声血流指标升高,且与患者的围生儿结局密切相关。     

子痫前期患者血清AFP、D-二聚体、PLGF水平对母体及妊娠结局影响

目的:分析子痫前期(PE)患者血清甲胎蛋白(AFP)、D-二聚体(D-dimer)及胎盘生长因子(PLGF)水平对母体及妊娠结局的影响。方法:将本院2016年1月-2018年9月收治的330例PE患者分轻度PE组(n=117)、重度PE组(n=213),另选同期本院住院待产的正常妊娠产妇30例为对照组,检测各组孕妇血清AFP、D-dimer、PLGF水平,绘制受试者工作特征(ROC)曲线分析对PE的诊断预测效能;Spearman相关性分析各检测指标与病情的相关性;对PE患者妊娠结局的预测效能。结果:PE组与对照组AFP比较无差异(P>0.05),但D-dimer水平PE组高于对照组,PLGF低于对照组(P<0.05);D-dimer AUC值最高(387.51μg/L),预测PE的敏感度、特异度为80.6%、100.0%;PLGF AUC值次之(217.33pg/ml),预测PE的敏感度为96.7%,高于D-dimer。不同病情严重程度的PE患者血清AFP、PLGF水平未见差异(P>0.05),但D-dimer轻度PE组低于重度PE组(P<0.05)。AFP与PE病情程度未见相关性(r=0.093,P=0.078),D-dimer与PE病情程度正相关(r=0.796,P=0.000),PLGF与PE病情程度负相关(r=0.114,P=0.031)。PE患者中,母体发生并发症、胎儿结局不良者血清D-dimer水平高于无并发症、胎儿结局良好者(P<0.05),AFP、PLGF未见差异(P>0.05);D-dimer对PE患者并发症可发挥一定预测效能,以579.53μg/L为cut-off,预测PE患者并发症的敏感度、特异度为80.9%、61.9%,另两项血清指标对妊娠结局的预测效能不佳。结论:血清AFP、D-dimer、PLGF3个指标中,D-dimer对PE的预测价值及其与PE病情的相关性最为显著,用于预测PE患者母体并发症具有一定敏感度,但特异度不佳。