Vainio Merja, Riutta Asko, Koivisto Anna-Maija, Mäenpää Johanna
Department of Obstetrics and Gynecology, Hyvinkää Hospital, Hyvinkää, Finland.
Acta Obstet Gynecol Scand. 2004 Dec;83(12):1119-23. doi: 10.1111/j.0001-6349.2004.00396.x.
The aim of this study was to investigate the prostanoid production in pregnancies at high risk for hypertensive disorders, and the effect of low-dose acetylsalicylic acid (ASA) on prostanoids.
Ninety women with a bilateral notching in uterine arteries screened by Doppler ultrasound at 12-14 gestational weeks were randomized to the ASA (0.5 mg/kg/day) or placebo group. Forty-three women in both groups were followed up throughout the pregnancy. Urine samples were taken at baseline, and at 24-26 and 32-34 weeks of gestation to determine the urinary 11-dehydrothromboxane B(2) (u-11-dehydro-TxB(2)) and 2,3-dinor-6-keto-prostaglandin F(1alpha) (u-2,3-dinor-6-keto-PGF(1alpha)), the metabolites of thromboxane A(2) and prostacyclin, respectively.
In the pregnancies with pregnancy-induced hypertension (PIH) before 37 gestational weeks, the 2,3-dinor-6-keto-PGF(1alpha)/11-dehydro-TxB(2) ratio did not increase as much as in other pregnancies (P = 0.028). In the placebo group pregnancies with preeclampsia had significantly lower 2,3-dinor-6-keto-PGF(1alpha) (P = 0.019) at 12-14 weeks of gestation compared to other pregnancies. In the placebo group the 2,3-dinor-6-keto-PGF(1alpha)/11-dehydroTxB(2) ratio remained unchanged throughout the pregnancy, with no significant difference between pregnancies with a normal or an adverse outcome. In the ASA group the 2,3-dinor-6-keto-PGF(1alpha)/11-dehydro-TxB(2) ratio increased (P < 0.001, early vs. midpregnancy). Again, the changes were similar in pregnancies with a normal or an adverse outcome.
The balance of prostacyclin and thromboxane A(2) shifted in an unfavorable direction in pregnancies complicated by PIH. ASA had a favorable effect on the prostanoids.
本研究旨在调查患有高血压疾病高风险妊娠中的前列腺素生成情况，以及低剂量阿司匹林（ASA）对前列腺素的影响。
90名在妊娠12 - 14周时经多普勒超声筛查发现子宫动脉双侧切迹的女性被随机分为ASA组（0.5mg/kg/天）或安慰剂组。两组中的43名女性在整个孕期接受随访。在基线时以及妊娠24 - 26周和32 - 34周时采集尿液样本，以测定尿11 - 脱氢血栓素B₂（u - 11 - 脱氢 - TxB₂）和2,3 - 二去甲 - 6 - 酮 - 前列腺素F₁α（u - 2,3 - 二去甲 - 6 - 酮 - PGF₁α），它们分别是血栓素A₂和前列环素的代谢产物。
在妊娠37周前发生妊娠高血压（PIH）的妊娠中，2,3 - 二去甲 - 6 - 酮 - PGF₁α/11 - 脱氢 - TxB₂比值的升高幅度不如其他妊娠（P = 0.028）。在安慰剂组中，与其他妊娠相比，子痫前期妊娠在妊娠12 - 14周时的2,3 - 二去甲 - 6 - 酮 - PGF₁α显著降低（P = 0.019）。在安慰剂组中，2,3 - 二去甲 - 6 - 酮 - PGF₁α/11 - 脱氢 - TxB₂比值在整个孕期保持不变，正常结局和不良结局的妊娠之间无显著差异。在ASA组中，2,3 - 二去甲 - 6 - 酮 - PGF₁α/11 - 脱氢 - TxB₂比值升高（早期与中期妊娠相比，P < 0.001）。同样，正常结局和不良结局的妊娠变化相似。
在合并PIH的妊娠中，前列环素和血栓素A₂的平衡向不利方向转变。ASA对前列腺素有有益影响。
