PDF(Pubmed)
Abstract：
UNASSIGNED: Preeclampsia is a common and serious pregnancy-induced disease, with potential severe maternal and fetal complications. Recently, an increased lipoprotein (a) (Lp[a]) concentration, an important factor in cardiovascular diseases (CVDs) pathogenesis, has been identified as a sensitive and specific marker of preeclampsia severity. Although lipoprotein apheresis (LA) is currently used in patients with hyperlipoproteinemia(a) and CVD, real-life data on its efficacy among pregnant women with an increased risk of preeclampsia are limited.
UNASSIGNED: We present the case of a pregnant woman with severely elevated Lp(a), two previous episodes of the acute coronary syndrome and multivessel coronary disease treated with long-term LA before pregnancy, and a high risk of preeclampsia (as assessed using combined test screening). An increased pulsatility index and early diastolic notch were observed on Doppler interrogation at 18 weeks\' gestation. Biweekly LA therapy was re-initiated at 21 weeks\' gestation. The LA safely removed 70% of the serum Lp(a) concentration and reduced low-density lipoprotein-cholesterol (LDL-C) levels by 60%. We also observed an improvement in her urine protein/creatinine ratio, a reduction in the pulsatility index, and a notch on Doppler interrogation. The pregnancy lasted until week 36, when severe preeclampsia prompted an emergency cesarean delivery.
UNASSIGNED: Pregnancy in women with elevated Lp(a), CVD, and a high risk of preeclampsia can present challenges in clinical management. Our case report indicates the benefits of LA in preventing atherosclerotic CVD progression during pregnancy, its potential influence on uteroplacental circulation, and prolongation of pregnancy for the best possible intrauterine fetus development. LA may be considered as a treatment option during pregnancy in such conditions. In addition, in pregnant women with CVD, we suggest screening using a combined test and measurement of Lp(a) as a marker of preeclampsia severity.
UNASSIGNED: We present the case of a pregnant woman with severely elevated Lp(a), two previous episodes of the acute coronary syndrome and multivessel coronary disease treated with long-term LA before pregnancy, and a high risk of preeclampsia (as assessed using combined test screening). An increased pulsatility index and early diastolic notch were observed on Doppler interrogation at 18 weeks\' gestation. Biweekly LA therapy was re-initiated at 21 weeks\' gestation. The LA safely removed 70% of the serum Lp(a) concentration and reduced low-density lipoprotein-cholesterol (LDL-C) levels by 60%. We also observed an improvement in her urine protein/creatinine ratio, a reduction in the pulsatility index, and a notch on Doppler interrogation. The pregnancy lasted until week 36, when severe preeclampsia prompted an emergency cesarean delivery.
UNASSIGNED: Pregnancy in women with elevated Lp(a), CVD, and a high risk of preeclampsia can present challenges in clinical management. Our case report indicates the benefits of LA in preventing atherosclerotic CVD progression during pregnancy, its potential influence on uteroplacental circulation, and prolongation of pregnancy for the best possible intrauterine fetus development. LA may be considered as a treatment option during pregnancy in such conditions. In addition, in pregnant women with CVD, we suggest screening using a combined test and measurement of Lp(a) as a marker of preeclampsia severity.
摘要：
■先兆子痫是一种常见且严重的妊娠诱发疾病，潜在的严重母婴并发症。最近,脂蛋白（a）（Lp[a]）浓度增加，心血管疾病（CVDs）发病机制的重要因素，已被确定为先兆子痫严重程度的敏感和特异性标志物。尽管脂蛋白单采术（LA）目前用于高脂蛋白血症（a）和CVD患者，在先兆子痫风险增加的孕妇中,其疗效的实际数据有限.
■我们介绍了一名Lp（a）严重升高的孕妇的情况，妊娠前曾发生过两次急性冠状动脉综合征和多支血管冠状动脉疾病,和先兆子痫的高风险（使用联合测试筛查评估）。妊娠18周时，多普勒询问观察到搏动指数增加和舒张早期切迹。每两周一次的LA治疗在妊娠21周时重新开始。LA安全地去除血清Lp（a）浓度的70％，并将低密度脂蛋白胆固醇（LDL-C）水平降低60％。我们还观察到她的尿蛋白/肌酐比率有所改善，搏动指数的降低，和多普勒审讯上的一个缺口。妊娠持续到第36周，当时严重的先兆子痫促使紧急剖宫产。
■Lp（a）升高的女性怀孕，CVD,先兆子痫的高风险可能给临床管理带来挑战。我们的病例报告表明LA在预防妊娠期间动脉粥样硬化CVD进展方面的益处，它对子宫胎盘循环的潜在影响，和延长妊娠以获得最佳的宫内胎儿发育。在这种情况下，LA可以被认为是怀孕期间的治疗选择。此外,在患有CVD的孕妇中，我们建议使用联合检测和测量Lp(a)作为先兆子痫严重程度的指标进行筛查.
■我们介绍了一名Lp（a）严重升高的孕妇的情况，妊娠前曾发生过两次急性冠状动脉综合征和多支血管冠状动脉疾病,和先兆子痫的高风险（使用联合测试筛查评估）。妊娠18周时，多普勒询问观察到搏动指数增加和舒张早期切迹。每两周一次的LA治疗在妊娠21周时重新开始。LA安全地去除血清Lp（a）浓度的70％，并将低密度脂蛋白胆固醇（LDL-C）水平降低60％。我们还观察到她的尿蛋白/肌酐比率有所改善，搏动指数的降低，和多普勒审讯上的一个缺口。妊娠持续到第36周，当时严重的先兆子痫促使紧急剖宫产。
■Lp（a）升高的女性怀孕，CVD,先兆子痫的高风险可能给临床管理带来挑战。我们的病例报告表明LA在预防妊娠期间动脉粥样硬化CVD进展方面的益处，它对子宫胎盘循环的潜在影响，和延长妊娠以获得最佳的宫内胎儿发育。在这种情况下，LA可以被认为是怀孕期间的治疗选择。此外,在患有CVD的孕妇中，我们建议使用联合检测和测量Lp(a)作为先兆子痫严重程度的指标进行筛查.
