白血病抑制因子（LIF）在子痫前期患者胎盘组织中的表达

目的探讨白血病抑制因子（LIF）在子痫前期患者胎盘组织中表达的临床意义。方法采用链霉菌抗生物素蛋白－过氧化酶连接（SP）法,对在正常妊娠（正常妊娠组）、子痫前期（轻度子痫前期组和重度子痫前期组）孕妇胎盘组织中LIF的表达进行组织学定位和半定量分析。结果3组孕妇胎盘组织中LIF均呈现阳性表达,阳性染色主要位于滋养细胞胞质中．胞核无明显着色。轻度子痫前期组和重度子痫前期组分别与正常妊娠组比较,胎盘组织的染色强度及范围显著减弱．差异有统计学意义（P〈0．01）,而轻度子痫前期组和重度子痫前期组的胎盘组织染色范围和强度比较,差异无统计学意义（P〉0．05）。结论LIF对维持正常妊娠有一定的保护作用;LIF在胎盘组织中的低表达．影响了滋养细胞的浸润导致胎盘浅着床．从而失去对正常妊娠的保护作用。LIF可能参与子痫前期的形成机制。     

Cathepsin D levels are reduced in patients with preeclampsia in Korean population

Objectives

To compare the circulating levels of cathepsin D in preeclamptic and normotensive pregnancies.

Design and methods

Fifty pregnant and 20 healthy non-pregnant patients were enrolled in this study. Of the 50 pregnant patients, 15 were preeclamptic and 35 patients were normotensive. Serum levels of soluble cathepsin D were measured with an enzyme-linked immunosorbent assay (ELISA) kit.

Results

Cathepsin D levels were significantly lower in preeclamptic patients than normotensive pregnant patients (p = 0.033). The serum levels of cathepsin D in preeclamptic and non-pregnant healthy patients showed similar results. The serum levels of cathepsin D were not positively correlated with preeclampsia severity or the incidence of delivery of small for gestational age infants.

Conclusions

We conclude that a reduced cathepsin D level is an important factor that may contribute to the pathogenesis of preeclampsia, possibly by inhibiting normal trophoblastic invasion. These results contribute to the understanding of this serious obstetric problem.     

Statins and angiogenesis in non-cardiovascular diseases

Statins inhibit HMG-CoA reductase by competitively inhibiting the active site of the enzyme, thus preventing cholesterol synthesis and reducing the risk of developing cardiovascular disease. Many pleiotropic effects of statins have been demonstrated that can be either related or unrelated to their cholesterol-lowering ability. Among these effects are their proangiogenic and antiangiogenic properties that could offer new therapeutic applications. In this regard, pro- and anti-angiogenic properties of statins have been shown to be dose dependent. Statins also appear to have a variety of non-cardiovascular angiogenic effects in many diseases, some examples being ocular disease, brain disease, cancer, preeclampsia, diabetes and bone disease, which are discussed in this review using reports from in vitro and in vivo investigations.     

硫酸镁对妊娠子痫前期子痫的治疗效果观察

目的探讨硫酸镁对妊娠子痫前期子痫进行治疗的临床疗效。方法选取近年来在本院治疗的妊娠子痫前期子痫患者76例作为研究对象,分为治疗组和对照组各38例。对照组患者进行一般性镇静治疗并加强观察,治疗组在对照组基础上采用硫酸镁进行治疗;观察两组患者的临床疗效及妊娠结局。结果治疗组患者在治疗过程中无药物过量和明显不良反应情况发生,未影响治疗。对照组有5例（13．2％）患者由轻度转为重度子痫前期,治疗组有4例（10．5％）,且无患者转为子痫。两组患者临床疗效和妊娠结局差异均无统计学意义（P〉0．05）。结论硫酸镁对妊娠子痫前期子痫进行治疗,治疗中严格控制剂量,无明显不良反应发生,临床疗效无统计学意义。     

Assessment of myocardial injury in neonates born to pregnant women with pregnancy complicated by severe preeclampsia by myocardial work indices: a prospective study北大核心CSCD

目的 应用心肌做功参数评估重度子痫前期孕妇子代新生儿期心肌损伤。 方法 前瞻性收集2020年6月至2021年4月重度子痫前期孕妇分娩的早产儿25例作为重度子痫前期组，同时收集无严重妊娠期并发症孕妇分娩的早产儿25例作为对照组，分别于出生后24 h内、48~72 h及14~28 d应用超声心动图检查测量常规参数，应用二维斑点追踪成像技术通过心肌二维应变联合无创测得的左室收缩压构建无创性左室压力-应变环计算心肌做功参数。 结果 与对照组相比，重度子痫前期组在出生后24 h内左室整体做功指数和整体有用功降低（P<0.05）；在出生后48~72 h左室整体做功效率降低，左室整体无用功增加（P<0.05）；在出生后14~28 d左室整体做功效率仍降低（P<0.05）。 结论 重度子痫前期孕妇分娩的早产儿在新生儿期持续存在亚临床心肌损伤。     

孕中期母血清胎盘蛋白13作为预测子痫前期标记物的初步研究

目的:探讨孕中期(16 ～18周)孕妇血清胎盘蛋白13(PP13)水平变化对子痫前期(PE)的预测价值.方法:选取22例PE患者(病例组)和55例正常孕妇(对照组),于孕16～18周行唐氏筛查的同时采用时间分辨荧光免疫技术(DEFILA)检测两组孕妇的血清PP13水平.结果:孕16、17、18周时对照组孕妇的PP13中位数分别为47.5、49和51.2pmol/L,随着孕周增加而增加(r=1.0,P＜0.01)；病例组孕妇的PP13中位数分别为52.7、46.7和42.9pmol/L,随着孕周增加而下降(r=-1.0,P＜0.01).血清PP13水平用MOM值表示,病例组与对照组无显著差异(1.04MOM vs 1.00MOM,P＞0.05).结论:孕16 ～18周时孕妇血清PP13的单次检测不能预测PE,但连续监测可能对预测PE有一定的价值.     

Glomerular Disturbances in Preeclampsia: Disruption Between Glomerular Endothelium and Podocyte Symbiosis

Background. Preeclampsia (PE) is the commonest cause of glomerular disease worldwide. Glomerular endotheliosis has been considered as the hallmark of PE, but this lesion is also found in non-proteinuric hypertensive pregnant women. Lately, podocyte alterations have been related to PE. Proposal. Although it has been demonstrated that glomerular endothelium and podocyte alterations are related to PE, we could locate no formal academic discussion that integrates these two phenomena. The demonstration that alterations of the expression of vascular endothelial growth factor (VEGF) by podocytes result in a dramatic endothelial phenotype and that induced production of endothelin-1 by glomerular endothelium provokes podocyte damage could indicate that glomerular lesions in PE result from disruption of the symbiosis between these cells rather than from events occurring independently. We shall try to describe a holistic way of viewing renal disease in PE women, in which the hypertensive emergency is produced by the effects of antiangiogenic proteins on the vascular endothelium, while renal lesion and proteinuria result from the effects of these proteins on both the glomerular endothelium and the podocyte. Conclusions. VEGF deficiency within the glomerulus in women with PE leads to the disruption of podocyte and glomerular endothelium symbiosis. The evidence demonstrating that exogenous VEGF administration in a rat model of PE could alleviate hypertension and proteinuria in these animals are encouraging in view of looking for therapeutic approaches in this direction, nonetheless further evidence should be provided in humans to directly demonstrate that VEGF supplementation could mitigate the symptoms of PE.     

The Evaluation of the Oxidative State of Low-Density Lipoproteins in Intrauterine Growth Restriction and Preeclampsia

Objective. To evaluate the oxidative state of lipoproteins in pregnancies complicated by intrauterine growth restriction (IUGR) in comparison to preeclampsia (PE) and healthy pregnant control subjects (CN). Methods. Maternal serum of 20 PE, 29 IUGR, and 29 gestational age-matched CN were analyzed. Total cholesterol (TC), low-density lipoprotein (LDL)-bound cholesterol (LDL-C), and oxidized LDL (oxLDL) concentration were measured once between 25 and 34 weeks of gestation. Statistical estimates were performed by Student's t-test. Results. Serum concentrations of LDL-C and TC were significantly reduced in IUGR [LDL-C: CN – mean = 146 mg/dL, SD = ± 40.1; IUGR – mean = 102 mg/dL, SD = ± 27.3 (p < 0.0001); PE – mean = 130 mg/dL, SD = 38.8 mg/dL; TC: CN – mean = 259/dL, SD = ± 46.8; IUGR – mean = 218 mg/dL, SD = ± 35.0 (p < 0.001); PE – mean = 244 mg/dL, SD = 48.2]. There was no significant difference in oxLDL/LDL-C ratio within the three groups (CN: mean = 0.76, SD = 0.24; IUGR: mean = 0.74, SD = 0.12; PE: mean = 0.77, SD = 0.22). Conclusion. Our results show a lower maternal LDL-C and TC concentration in IUGR pregnancies. These data contribute to the hypothesis of a decreased cholesterol supply to the fetus in IUGR. However, we could not confirm the hypothesis of an altered oxidative state in neither IUGR nor PE.     

Effectiveness of Antihypertensive Drugs in the Treatment of Hypertension in Pregnancy

The purpose of this open, prospective, randomized, comparative study was to examine the effectiveness of atenolol, a cardioselective beta₁ blocker, alphamethyldopa, an alpha-adrenergic antagonist, and ketanserin, a serotonin receptor antagonist, in the treatment of 90 patients (N–30 each) with severe chronic hypertension (ChH) during pregnancy or severe pregnancy-induced hypertension, with or without proteinuria in either case.

Arterial blood pressure (BP) for each drug group was analyzed at the onset of treatment, weekly for three weeks, and at the end of pregnancy. After one week of treatment a significant drop in BP was observed in the three groups of patients. Thereafter BP remained stable until the end of gestation, when a slight increase in BP was observed, especially in the group of patients treated with ketanserin.

No significant difference was observed between the groups in mean birthweight and perinatal morbidity and mortality. No adverse effects from the drugs on the fetus or newborn were observed. No significant difference was observed among the three drugs in their antihypertensive effect. However, given the relatively small numbers of patients studied, definitive statements regarding the relative efficacy and safety of alphamethyldopa, ketanserin and atenolol cannot be made. Thus, additional, larger controlled trials of these agents are required.     

Urinary Inositol Phosphoglycan P-Type as A Marker for Prediction of Preeclampsia and Novel Implications for the Pathophysiology of This Disorder

Objective.Hypertensive disorders represent the most common complications of human pregnancy with substantial impact on fetal and maternal outcomes. Inositol phosphoglycan P-type has recently been identified as a novel marker of preeclampsia, the most severe form of hypertension during pregnancy, with a significant increase in urinary excretion preceding the clinical diagnosis. Methods.A prospective, longitudinal study was carried out to assess the potential of urinary levels of inositol phosphoglycan P-type as a screening test for preeclampsia. A specific ELISA-based test was used to assess urinary levels of P-IPG. Results.Nine patients out of 93 women recruited (496 urinary samples were collected) went on to develop preeclampsia in a cohort of women with high-risk pregnancies. A cut-off value of urinary inositol phosphoglycan P-type was identified by ROC analysis providing a sensitivity and specificity for the current protocol of 88.9% and 62.7%, respectively. Twenty-three women with healthy pregnancies had sporadic episodes of increased excretion of inositol phosphoglycan P-type during pregnancy that consistently resolved back to normal baseline without development of preeclampsia. There was no correlation of urine levels of inositol phosphoglycan P-type and urine protein and patients with gestational hypertension had normal levels of urine inositol phosphoglycan P-type. Conclusions.These findings suggest that, given the rapid raise of P-IPG before the onset of the disease, multiple assessments may help at identifying women at risk of developing preeclampsia.