Shinagawa T, Suzuki S, Sawa R, Yoneyama Y, Asakura H, Araki T
Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113, Japan.
Arch Gynecol Obstet. 2002 Dec;267(2):72-5. doi: 10.1007/s00404-001-0283-2.
The aim of this study was to evaluate the relationship between the vascular resistance in uterine arteries and the maternal release of adenosine and endothelin-1 in twin gestations with and without preeclampsia. Uterine artery Doppler velocimetry and maternal arterial blood sampling were performed in 14 women with normal singleton gestation, nine women with singleton gestation with preeclampsia, eight women with dichorionic twin gestation without preeclampsia and six women with dichorionic twin gestation with preeclampsia at 28-34 weeks' gestation. In normal singleton gestations, the average maternal uterine arteries pulsatility index (PI), plasma adenosine and endothelin-1 levels were 0.64+/-0.07, 0.34+/-0.11 micromol/l and 1.29+/-0.31 pg/ml, respectively. In preeclamptic singleton gestations, increased vascular resistance in the uterine arteries (PI: 0.85+/-0.14, P<0.05) and the elevation of maternal arterial plasma adenosine (0.48+/-0.14 micromol/l, P<0.05) and endothelin-1 levels (1.91+/-0.55 pg/ml, P<0.05) were observed. In the normal twin gestation group, the average maternal vascular resistance of the uterine arteries (PI: 0.55+/-0.09) was lower than that in the normal singleton gestation group, while the average plasma adenosine levels (0.47+/-0.12 micromol/l) were higher than that in normal singleton gestation. On the other hand, significant increased plasma endothelin-1 concentrations (1.87+/-0.42 pg/ml) were observed in the preeclamptic twin gestation groups without changes in plasma adenosine levels or vascular resistance of uterine arteries. Our results indicate the presence of different mechanisms for the pathogenesis of preeclampsia between twin and singleton gestations.
本研究的目的是评估有或没有先兆子痫的双胎妊娠中子宫动脉血管阻力与母体腺苷和内皮素-1释放之间的关系。在孕28 - 34周时，对14例单胎妊娠正常的女性、9例单胎妊娠合并先兆子痫的女性、8例双绒毛膜双胎妊娠无先兆子痫的女性以及6例双绒毛膜双胎妊娠合并先兆子痫的女性进行了子宫动脉多普勒测速和母体动脉血采样。在单胎妊娠正常组中，母体子宫动脉搏动指数（PI）、血浆腺苷和内皮素-1水平的平均值分别为0.64±0.07、0.34±0.11微摩尔/升和1.29±0.31皮克/毫升。在单胎妊娠合并先兆子痫组中，观察到子宫动脉血管阻力增加（PI：0.85±0.14，P<0.05）以及母体动脉血浆腺苷升高（0.48±0.14微摩尔/升，P<0.05）和内皮素-1水平升高（1.91±0.55皮克/毫升，P<0.05）。在双胎妊娠正常组中，母体子宫动脉的平均血管阻力（PI：0.55±0.09）低于单胎妊娠正常组，而血浆腺苷平均水平（0.47±0.12微摩尔/升）高于单胎妊娠正常组。另一方面，在双胎妊娠合并先兆子痫组中观察到血浆内皮素-1浓度显著升高（1.87±0.42皮克/毫升），而血浆腺苷水平和子宫动脉血管阻力无变化。我们的结果表明，双胎妊娠和单胎妊娠先兆子痫的发病机制存在不同。
