PDF(Pubmed)
Abstract：
Serpin E1/PAI-1, N-terminal pro-brain natriuretic peptide (NTpro-BNP) and neuropilin-1 are markers which have been associated with endothelial dysfunction. However, data on the levels of these markers in PE is limited. The limited data on the pathophysiology of PE in relation to these markers necessitated the study. This was a multicentre case-control study conducted at the Obstetrics and Gynaecology Department of the Tamale Teaching Hospital, the Bawku Presbyterian Hospital and the Bolgatanga Regional Hospital. Out of 520 consenting pregnant women, 127 pregnant women met the inclusion criteria (53 with PE and 74 controls) and were included in this study. Venous, placental, cord and peripheral blood were collected for biomarker assay, haematological parameters and placental parasite determination. Placental tissue sections were obtained for placental malaria and histopathological lesions associated with hypoperfusion. Maternal heart rate and foetal umbilical artery Doppler impedance indices; resistance index (RI) and systolic diastolic (SD) ratio were determined to confirm utero-placental hypoperfusion. Significantly higher proportions of foeto-maternal complications; eclampsia, low birth weight (LBW), neonatal intensive care unit admissions (NICU), intrauterine growth restriction (IUGR), caesarian deliveries and early gestational age at delivery were associated with PE. Women with PE had lower concentrations of platelet (p = 0.02) whereas red cell distribution width (RDW) was markedly elevated (p = 0.01). NTPro-BNP concentration was markedly elevated (p = 0.01) in women with PE whereas neuropilin-1 concentration was lower (p = 0.03) compared to the non-PE group. Maternal heart rate was elevated in women with PE and Doppler resistance indices (RI and SD) were significantly elevated in foetuses of PE women than foetuses of the controls. Placental mal-perfusion lesions were higher in women with PE compared to the non-PE group. Women with PE had increased risk of adverse foeto-maternal complications, significantly associated with placental mal-perfusion lesions, had reduced platelet concentration and elevated RDW-CV levels. NTPro-BNP, RI and SD are elevated in women with PE whereas neuropilin-1 concentration is reduced. Significant changes in these pathological variables in PE women is indicative of significant derangement in endothelial function culminating in adverse maternal and perinatal outcomes of pregnancy.
摘要：
SerpinE1/PAI-1，N末端脑钠肽前体（NTpro-BNP）和神经纤毛蛋白-1是与内皮功能障碍相关的标志物。然而,关于这些标志物在PE中的水平的数据是有限的。与这些标志物相关的PE病理生理学的有限数据需要进行研究。这是一项在塔马利教学医院妇产科进行的多中心病例对照研究,Bawku长老会医院和Bolgatanga地区医院。在520名同意的孕妇中，127名孕妇符合纳入标准（53名PE和74名对照），并纳入本研究。静脉,胎盘,收集脐带血和外周血进行生物标志物检测，血液学参数和胎盘寄生虫测定。获得胎盘组织切片的胎盘疟疾和与灌注不足相关的组织病理学病变。母亲心率和胎儿脐动脉多普勒阻抗指数；确定阻力指数（RI）和收缩期舒张（SD）比率以确认子宫胎盘灌注不足。胎儿母体并发症的比例明显更高；子痫，低出生体重（LBW），新生儿重症监护病房（NICU），宫内生长受限（IUGR），剖腹产和分娩早期胎龄与PE相关.患有PE的女性血小板浓度较低（p=0.02），而红细胞分布宽度（RDW）显着升高（p=0.01）。与非PE组相比，PE女性的NTPro-BNP浓度显着升高（p=0.01），而神经纤毛素-1浓度较低（p=0.03）。PE女性的母亲心率升高，PE女性胎儿的多普勒阻力指数（RI和SD）显着升高。与非PE组相比，PE女性的胎盘灌注病变更高。女性PE有增加的风险不良的胎儿-母体并发症，与胎盘灌注不良病变显著相关，血小板浓度降低，RDW-CV水平升高。NTPro-BNP,PE女性的RI和SD升高，而神经纤毛素-1浓度降低。PE妇女中这些病理变量的显着变化表明内皮功能的显着紊乱，最终导致不良的母体和围产期妊娠结局。
