Florio Pasquale, Torricelli Michela, De Falco Giulia, Leucci Eleonora, Giovannelli Alessia, Gazzolo Diego, Severi Filiberto M, Bagnoli Franco, Leoncini Lorenzo, Linton Elizabeth A, Petraglia Felice
Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy.
J Hypertens. 2006 Sep;24(9):1831-40. doi: 10.1097/01.hjh.0000242408.65783.b2.
We evaluated maternal and fetal plasma levels and placental mRNA expression of urocortin, a placental vasoactive neuropeptide, in singleton pregnancies (n = 70) complicated by hypertensive disorders classified as gestational hypertension (n = 36), pre-eclampsia (n = 19), and pre-eclampsia complicated by intrauterine growth restriction (PE/IUGR, n = 15), and in 70 healthy normotensive singleton pregnancies.
Plasma levels were assayed by radioimmunoassay, fetal biometry by ultrasound scans, utero-placental and fetal perfusion by Doppler velocimetry, and placental urocortin mRNA expression by quantitative real time reverse transcriptase-polymerase chain reaction. The main outcome measures were the correlation of urocortin concentrations with patterns of the utero-placental and fetal circulation, and the early prediction of a poor neonatal outcome such as the occurrence of perinatal death and intraventricular hemorrhage.
Maternal and fetal urocortin levels were significantly (both P < 0.001) higher in gestational hypertension, pre-eclampsia and PE/IUGR women than in controls, and correlated with Doppler velocimetry patterns. Fetal concentrations were significantly (P < 0.0001) higher than and significantly (P < 0.0001) correlated to maternal levels. Placental mRNA expression did not change. Ten out of 140 newborns had a poor neonatal outcome, with an overall prevalence of 7.14% (pretest probability). Using the receiver operator characteristics curve analysis cut-off values, the probability of a poor neonatal outcome was 66.7% when urocortin was used, and was 0% if levels were unaltered.
Maternal and fetal urocortin levels are increased in hypertensive disorders of pregnancy. Since urocortin has vasoactive properties, the evidence of increased urocortin levels in hypertensive disorders may represent an adaptive fetal response.
我们评估了单胎妊娠（n = 70例）中尿皮质素（一种胎盘血管活性神经肽）的母体和胎儿血浆水平以及胎盘mRNA表达情况。这些单胎妊娠合并高血压疾病，分为妊娠期高血压（n = 36例）、子痫前期（n = 19例）以及子痫前期合并胎儿生长受限（PE/IUGR，n = 15例），并与70例血压正常的健康单胎妊娠进行比较。
采用放射免疫分析法检测血浆水平，通过超声扫描进行胎儿生物测量，用多普勒测速法测量子宫胎盘和胎儿灌注情况，并用定量实时逆转录聚合酶链反应检测胎盘尿皮质素mRNA表达。主要观察指标为尿皮质素浓度与子宫胎盘和胎儿循环模式的相关性，以及对围产期死亡和脑室内出血等不良新生儿结局的早期预测。
妊娠期高血压、子痫前期和PE/IUGR女性的母体和胎儿尿皮质素水平显著高于对照组（均P < 0.001），并与多普勒测速模式相关。胎儿浓度显著高于母体水平（P < 0.0001），且与母体水平显著相关（P < 0.0001）。胎盘mRNA表达未发生变化。140例新生儿中有10例出现不良新生儿结局，总体患病率为7.14%（检验前概率）。使用受试者工作特征曲线分析临界值，当使用尿皮质素时，不良新生儿结局的概率为6%，如果水平未改变则为0%。
妊娠高血压疾病中母体和胎儿尿皮质素水平升高。由于尿皮质素具有血管活性特性，高血压疾病中尿皮质素水平升高的证据可能代表胎儿的适应性反应。
