子痫前期与肾病

子痫前期是妊娠期高血压疾病中病情较重的一种，常伴有肾脏损害或（和）慢性肾炎、肾病综合征，对母婴危害较大。目前公认胎盘浅着床、向母体血液中释放大量血管活性物质和细胞毒性物质在子痫前期发病中起重要作用，继发血管内皮损伤是其发病的中心环节；肾脏病理变化是非特异性内皮细胞病。子痫前期患者脂代谢明显异常，蛋白尿是血脂升高的重要因素，高血脂也参与了子痫前期发病。对其应综合治疗。     

子痫前期与肾病

子痫前期是妊娠期高血压疾病中病情较重的一种,常伴有肾脏损害或(和)慢性肾炎、肾病综合征,对母婴危害较大.目前公认胎盘浅着床、向母体血液中释放大量血管活性物质和细胞毒性物质在子痫前期发病中起重要作用,继发血管内皮损伤是其发病的中心环节;肾脏病理变化是非特异性内皮细胞病.子痫前期患者脂代谢明显异常,蛋白尿是血脂升高的重要因素,高血脂也参与了子痫前期发病.对其应综合治疗.     

子痫前期小鼠肾脏Perlecan蛋白表达对血管内皮生成的影响研究

目的 探讨子痫前期小鼠肾脏中Perlecan蛋白表达下降对血管内皮生成及其功能的影响.方法 构建正常孕鼠和子痫前期样小鼠模型,在细胞水平构建HSPG2条件肾敲低小鼠模型,观察肾脏Perlecan蛋白表达变化、Ras/Raf-1/MEK/ERK信号通路相关蛋白含量变化以及血管内皮细胞的功能改变.结果 成功构建子痫前期小鼠...     

Perlecan蛋白在子痫前期小鼠肾脏中的变化及作用机制研究

目的:探讨Perlecan蛋白在子痫前期(PE)小鼠肾脏中的变化及其作用机制.方法:构建正常孕鼠、PE样小鼠模型(动物水平)及HSPG2特异性肾敲低小鼠模型并分离肾小球内皮细胞(细胞水平),对比观察小鼠肾脏基底膜负电荷改变、Perlecan蛋白及其降解酶Hpa含量变化,同时检测PI3K/AKT/mTOR信号通路相关蛋白...     

重度子痫前期诊断标准临床意义探讨

目的 从临床实践方面进一步探讨我国最近制定的妊娠期高血压疾病重度子痢前期诊断分类标准的临床意义。方法 收集我院1992年1月至2003年12月诊治的妊娠期高血压疾病493例，其中1992年1月至1997年12月6年内按重度妊高征诊断标准诊断的病例73例(A组)，1998年1月至2003年12月6年内按重度子痫前期诊断标准判断的病例119例(B组)：分析493例按我国过去沿用的妊高征分类标准诊断的各类妊高征患者中有关脏器损害的临床症状及体征的发生率，并比较A、B两组不同标准判断的重度子痈前期的母婴预后。结果 重度妊高征中各项有关脏器损害临床表现的发生率较高，中度妊高征亦有一定的发生率，但较重度妊高征低：B组低体重儿、新生儿窒息、严重并发症及子痫的发生率均较A组低，两组比较差异有显著性意义，两组围生儿死亡率比较差异无统计学意义。结论 我国目前参照世界卫生组织通用标准提出的妊娠期高血压疾病重度子痫前期分类诊断标准体现了有关脏器损害的程度，有一定客观依据和临床价值。包括了过去旧的分类诊断方法中的重度妊高征和部分中度妊高征患者，有利于妊娠期高血压疾病的防治，减少不良妊娠结局。     

妊娠期高血压疾病降压的再认知及管理与子痫前期防范

妊娠期高血压疾病是导致母胎不良预后的主要原因之一。对慢性高血压孕妇加强孕前管理,对妊娠期高血压疾病孕妇进行孕期血压的规范化管理,对减少严重并发症非常重要。     

子痫前期头颅磁共振异常高危因素分析

目的:探讨子痫前期头颅磁共振异常的高危因素.方法:回顾分析2017年1月至2019年12月在南京大学医学院附属鼓楼医院妇产科分娩的子痫前期及慢性高血压并发子痫前期并接受头颅磁共振检查者,根据影像学检查结果,分为磁共振异常组和正常组.比较两组孕妇的一般临床资料、入院后血压评估、实验室检查结果,通过二元logis-tic回...     

复发性子痫前期

子痫前期是妊娠期间的严重并发症.随着国家生育政策的调整,复发性子痫前期成为产科工作者面临的新的临床问题.文章将就复发性子痫前期的发生率、影响因素、预防、孕期保健、预后以及对母体远期影响等方面进行介绍,以提高对复发性子痫前期整体诊治水平.     

妊娠期高血压疾病患者血浆H_2S水平及其与早发型重度子痫前期的相关性

目的:探讨妊娠期高血压疾病(PIH)患者血浆硫化氢(H_2S)水平变化,及其与子痫前期(PE),特别是早发型重度子痫前期(EOSP)的相关性。方法:选取148例PIH患者,其中64例重度PE(SP)组、40例轻度PE(MP)组、44例单纯妊娠期高血压(GH)组。同期选取148例与之匹配的正常孕妇为对照组。检测四组患者的血浆H_2S浓度。结果:SP组、MP组、GH组和对照组的血浆H_2S水平比较,差异有统计学意义(P<0.01),SP组血浆H_2S浓度最低(P<0.01),对照组血浆H_2S浓度最高(P <0.01)。血浆H_2S水平与PE疾病严重程度呈负相关(r=-0.382,P<0.01)。血浆H_2S水平判断发生EOSP疾病的ROC曲线下面积为0.746(95%CI为0.677～0.815,P<0.001)。结论:PIH患者的血浆H_2S表达较正常孕妇显著下降,血浆H_2S水平在一定程度上可用于判断PE疾病进展及EOSP的发生。     

子痫前期再发的防范

子痫前期（PE）是造成母儿发病和死亡的常见妊娠期并发症,尽管相比经产妇,其在初产妇人群中的发生率更高。然而,前次妊娠有PE病史者,再次妊娠则属于再发高风险人群,且前次发病孕周越早,或并发子痫、HELLP综合征、胎儿生长受限等,再次发病的概率更高,程度更重。有关PE再发的研究对产科医生极具挑战性,又值再生育人群高峰,如何做好孕前咨询,分层管理,采取合适的预防措施,监测病情和适时分娩,争取母儿利益最大化,是产科医生临床处理的重点。     

肾脏病史女性孕前保健

慢性肾脏病（CKD）妊娠不良结局包括流产、并发子痫前期、胎儿发育异常、胎儿生长受限、早产等。CKD女性妊娠需多学科共同管理,调整使用对胎儿影响较小的药物;帮助CKD患者选择合适的妊娠时机;指导患者调整生活状态,适应孕期的生理变化。     

Preeclampsia in women with chronic kidney disease

Objective: Women with chronic kidney disease have an increased risk of developing preeclampsia and its severe complications. Currently, there are no assessments available in order to quantify such risk. The aim of the study is to establish the incidence of superimposed preeclampsia in women with chronic kidney disease according to Serum creatinine (SCr) level. Methods: Pregnant women with chronic kidney disease were retrospectively identified from January 2000 to July 2010. We defined two groups according to SCr: Group 1: SCr ≤ 125 µmol/l; Group 2: SCr > 125 µmol/l. Incidence of preeclampsia, early preeclampsia (delivery <34 weeks), gestational age (GA) at diagnosis and delivery outcome were assessed. Results: Ninety-three nephropatic women were considered for the analysis. Group 2 (n?=?14) compared with Group 1 (n?=?79) had an increased incidence of preeclampsia (78.6% vs. 25.3%; p?<?0.0001), an increased rate of pregnancy complications as early preeclampsia (82% vs. 38%; p?<?0.03), a lower GA at diagnosis (29?±?2 vs. 33?±?1 weeks; p?<?0.04) and a lower GA at delivery (30?±?2 weeks vs. 34?±?1; p?<?0.04). Conclusion: Women with chronic kidney disease and an increased creatinine threshold have a high risk of developing preeclampsia and delivering preterm.     

自身免疫性疾病子痫前期的防范

子痫前期是常见的妊娠期并发症,孕产妇及围产儿患病率和病死率较高,以妊娠20周后出现高血压和蛋白尿为主要临床表现。在子痫前期出现临床症状之前对子痫前期高危人群进行预测较为困难。系统性红斑狼疮（SLE）和抗磷脂综合征（APS）患者妊娠期子痫前期发生的风险更高。对SLE和APS患者在妊娠期间子痫前期发病机制的理解有助于解释这些自身免疫性疾病患者为什么子痫前期发生率增加。对高危SLE和APS患者的子痫前期进行早期预测和识别,对这些高危患者进行密切监测和治疗,是改善不良母儿结局的关键。对高危SLE和APS患者使用小剂量阿司匹林预防治疗是迄今为止最好的子痫前期的预防方法。     

Risk of coronary artery disease in women with history of pregnancies complicated by preeclampsia and LBW

Women with a history of pregnancy complicated by preeclampsia or intrauterine growth restriction and low infant birth weight looks at a higher risk for subsequent ischemic heart disease. Objective: To determine the relationship between pregnancy complications and maternal coronary artery disease (CAD) in the future. Materials and method: We performed a case-control study on 690 patients (345 patients in each group) referred to Tehran Heart Center. Women with CAD were in the case group and women without CAD were in the control group. The history of pregnancy complications (including preeclampsia, low birth weight [LBW] delivery, preterm labor and gestational hypertension) was evaluated in the two groups. Results: 12.5% of the patients in the case group had a history of preeclampsia, compared with the control group (1.7%). (p?<?0. 0001). Seven percent of the patients in the case group and 0.9% of the patients in the control group had history of LBW delivery. The difference was significant (p?<?0.0001). A history of preterm labor was recorded in 11% of cases and 3.2% of controls. Performing multivariate analysis showed that there is a strong association between preeclampsia and CAD (OR: 16.92; 95% CI; p?<?0.0001), LBW delivery and CAD (OR: 6.52; 95% CI; p: 0.0038), and also between high parity and CAD. (OR: 1.135; 95% CI; p: 0.0479). Conclusion: Our results suggest preeclampsia, LBW delivery and high parity of the mother as independent risk factors for CAD in the future.     

Markers of preeclampsia and the relationship to cardiovascular disease: review of the twenty-first century literature

Objective.?The objective of this article was to review the literature to identify the most promising markers of preeclampsia (PE) and the relationship to cardiovascular disease to gain a better understanding of the mechanism of PE to identify women at risk for cardiovascular disease to improve their outcomes.

Methods.?Forty case–control studies were assessed for relationships between different serum markers to identify PE and to identify markers that may predict women who may be at greater risk for cardiovascular sequela in later life.

Results.?Angiogenic, proteomic, and tumor necrosis markers were the most promising and important in the development of PE. The interplay among various growth factors, hormones, proteins, and other molecular compounds appears to be critical in the development of PE. Specific angiogenic (sVEGF, PLGF) and antiangiogenic (sFlt-1, sENG) markers and proteomic markers (fibrinogen and a-1-antichymotrypsin, SERPINA1, albumin, 1-antichymotryps) are the most promising markers of PE. Evidence of metabolic abnormalities associated with PE and common markers with cardiovascular disease include free leptin concentration which increases in normal pregnancy and is further increased in PE.

Conclusions.?Markers are important to help understand disease, potentially identify women at risk to improve their outcomes, design therapies to ameliorate symptoms so that pregnancy can be prolonged and neonatal outcomes improved, and provide a better understanding the link between PE and increased risk for disease later in life.     

Homocysteine plasma concentration levels for the prediction of preeclampsia in women with chronic hypertension

OBJECTIVE: The purpose of this study was to evaluate prospectively midtrimester homocysteine concentration levels for the prediction of superimposed preeclampsia in women with chronic hypertension. STUDY DESIGN: Between March 1, 2000, and February 1, 2002, pregnancies that were complicated by chronic hypertension that required medication had homocysteine, vitamin B(12), and folate concentrations measured between 16 and 20 weeks of gestation. All women received folate supplementation. An upper limit threshold for increased homocysteine was defined as the mean value plus 2 SDs. RESULTS: Fifty-seven women were enrolled. Mean homocysteine concentration levels were 5.1+/-1.7 micromo/L for the 16 women who had preeclampsia compared with 4.7+/-1.3 micromo/L for the 41 women without preeclampsia (P=.56). Two of 16 women with preeclampsia (13%) had concentration levels that exceeded the 95th percentile (6.9 micromo/L) compared with 2 of 41 women (5%) without preeclampsia (P=.31). The sensitivity and specificity were 13% (95% CI, 1.6-38.3) and 95.1% (95% CI, 83.5-99.4), respectively. CONCLUSION: Second-trimester homocysteine concentration levels were not helpful in the prediction of preeclampsia in chronically hypertensive women.     

Renal disease in pregnancy

Renal disease affects approximately 3% of pregnant women in high income countries. Renal disease is associated with increased risks in pregnancy including pre-eclampsia, fetal growth restriction and loss of maternal renal function. Prepregnancy planning is essential to both optimize the maternal management and make sure that the woman has a proper understanding of the risks. Combining good prepregnancy care with multidisciplinary management in an appropriate centre will help minimize risks to both mother and baby.