Myatt L, Miodovnik M
Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, OH 45267, USA.
Semin Perinatol. 1999 Feb;23(1):45-57. doi: 10.1016/s0146-0005(99)80059-7.
The onset of preeclampsia at or near to term is associated with low maternal and neonatal morbidity and mortality. In contrast, those patients (1%) who suffer early onset preeclampsia engender significant maternal and perinatal morbidity and mortality. Therefore, because of the lack of proven prophylaxis for preeclampsia, prediction of risk or identification of subclinical disease is desirable to identify patients for more intensive observation. There are certain at-risk groups of patients such as those with chronic hypertension, pregestational diabetes, multifetal gestation, and previous preeclampsia. These patients account for the majority of cases of preeclampsia in multiparas, yet only account for 14% of preeclampsia in nulliparous women. Thus, the majority of cases of preeclampsia arises from nulliparous women without medical complications at low risk. Differences in the time of onset, severity, and organ system involvement suggest there may be different underlying etiologies that ultimately lead to preeclampsia manifested as the triad of maternal hypertension, proteinuria, and edema. Distinct markers therefore may identify subgroups of at-risk patients with separate underlying causes. These markers ultimately could be used for diagnosis of disease before the clinical appearance of maternal disease (hypertension, proteinuria, and edema). Based on data from patients with established disease, with the involvement of various organ systems, potential candidate markers would include renal function (kallikrein-creatinine); coagulation and fibrinolytic systems and platelet activation (platelet volume); markers of vascular function (fibronectin, prostacyclin, thromboxane) and oxidant stress (lipid peroxides, 8-isoprostane, antioxidants, anticardiolipin antibodies, hemoglobin, iron, transferrin, homocysteine, hypertriglyceridemia, albumin isoforms); placental peptide hormones (CRH, CRHbp, activin, inhibin, hCG); vascular resistance (uteroplacental flow velocity waveforms); genetic markers; insulin resistance; and glucose intolerance. Although cross-sectional studies have identified these potential markers, they need to be evaluated in prospective longitudinal studies with rigorous definition of outcome to determine if they are useful in predicting preeclampsia and whether they can identify different subgroups of patients.
足月或接近足月时发生的子痫前期与孕产妇和新生儿的低发病率及死亡率相关。相比之下，那些患有早发型子痫前期的患者（占1%）会导致孕产妇和围产期显著的发病率及死亡率。因此，由于缺乏已证实的子痫前期预防措施，对风险进行预测或识别亚临床疾病对于确定需要更密切观察的患者是很有必要的。有某些高危患者群体，如患有慢性高血压、孕前糖尿病、多胎妊娠以及既往有子痫前期病史的患者。这些患者占经产妇子痫前期病例的大多数，但在初产妇子痫前期中仅占14%。因此，大多数子痫前期病例发生在无医学并发症的低风险初产妇中。发病时间、严重程度和器官系统受累情况的差异表明，可能存在不同的潜在病因，最终导致子痫前期表现为孕产妇高血压、蛋白尿和水肿三联征。因此，不同的标志物可能会识别出具有不同潜在病因的高危患者亚组。这些标志物最终可用于在孕产妇疾病（高血压、蛋白尿和水肿）临床表现出现之前诊断疾病。基于已确诊疾病患者的数据，考虑到各种器官系统的受累情况，潜在的候选标志物将包括肾功能（激肽释放酶 - 肌酐）；凝血和纤维蛋白溶解系统以及血小板活化（血小板体积）；血管功能标志物（纤连蛋白、前列环素、血栓素）和氧化应激标志物（脂质过氧化物、8 - 异前列腺素、抗氧化剂、抗心磷脂抗体、血红蛋白、铁、转铁蛋白、同型半胱氨酸、高甘油三酯血症、白蛋白异构体）；胎盘肽激素（促肾上腺皮质激素释放激素、促肾上腺皮质激素释放激素结合蛋白、激活素、抑制素、人绒毛膜促性腺激素）；血管阻力（子宫胎盘血流速度波形）；遗传标志物；胰岛素抵抗；以及葡萄糖不耐受。尽管横断面研究已经确定了这些潜在标志物，但它们需要在前瞻性纵向研究中进行评估，对结果进行严格定义，以确定它们是否有助于预测子痫前期以及是否能够识别不同的患者亚组。
