Di Paolo Salvatore, Volpe Paolo, Grandaliano Giuseppe, Stallone Giovanni, Schena Antonio, Greco Pantaleo, Resta Leonardo, Selvaggi Luigi, Cincione Raffaele, Schena F Paolo, Gesualdo Loreto
Department of Emergency and Organ Transplant, Division of Nephrology, University of Bari, Italy.
J Nephrol. 2003 Sep-Oct;16(5):650-7.
This study investigated whether modifications of placental expression of endothelin-1 (ET-1), nitric oxide synthase (NOS) and tissue factor (TF) are associated with abnormal Doppler waveforms.
Fourteen pre-term severe preeclamptic (PE) women with fetal growth restriction (FGR) and 14 normal preg nant women underwent serial Doppler examination of the uterine and umbilical arteries (UA). Placental ET-1 and T expression was evaluated by in situ hybridization, NOS by NADPH-diaforase staining and in situ hybridization Doppler evaluation was extended to 11 female kidney transplant recipients (Tx), without FGR and/or PE, in wh we previously demonstrated a strong modification of placental ET-1/NOS vasoactive balance.
PE women showed a marked reduction of endothelial constitutive NOS (ecNOS) expression in the syncy tiotrophoblast layer of all villi, whereas ET-1 expression was unchanged. All cases showed abnormal uterine artery blood flow velocimetry, 13 out of 14 PE women showed abnormal UA Doppler waveforms. In contrast, all Tx women showed normal UA blood velocimetry, all but one woman displayed a normal uterine artery waveform pattern. The Doppler velocimetry abnormalities were significantly associated with only TF expression, which was markedly increased, exclusively, in the endothelial cells within the basal decidua of PE women.
The modification of ET-1/NOS vasoactive balance, per se, did not lead to Doppler impedance modifica tions in the UA and uterine arteries, observed in pre-term PE women with FGR. Instead, Doppler velocimetry modi fications appeared to correlate with endothelial cell activation, as revealed by increased TF expression.
本研究调查了内皮素 -1（ET-1）、一氧化氮合酶（NOS）和组织因子（TF）胎盘表达的改变是否与异常多普勒波形相关。
14例患有胎儿生长受限（FGR）的早产重度子痫前期（PE）妇女和14例正常孕妇接受了子宫和脐动脉（UA）的系列多普勒检查。通过原位杂交评估胎盘ET-1和T表达，通过NADPH - 黄递酶染色评估NOS，并将多普勒评估扩展至11例无FGR和/或PE的女性肾移植受者（Tx），我们之前已证明这些受者胎盘ET-1/NOS血管活性平衡有显著改变。
PE妇女所有绒毛合体滋养层的内皮型组成性NOS（ecNOS）表达明显降低，而ET-1表达未改变。所有病例均显示子宫动脉血流速度测定异常，14例PE妇女中有13例显示UA多普勒波形异常。相比之下，所有Tx妇女均显示UA血流速度测定正常，除1名妇女外所有妇女均显示子宫动脉波形模式正常。多普勒血流速度测定异常仅与TF表达显著相关，TF表达仅在PE妇女基蜕膜内的内皮细胞中显著增加。
在患有FGR的早产PE妇女中观察到的ET-1/NOS血管活性平衡改变本身并未导致UA和子宫动脉的多普勒阻抗改变。相反，如TF表达增加所显示，多普勒血流速度测定改变似乎与内皮细胞活化相关。
