Metsaars Wieneke P, Ganzevoort Wessel, Karemaker John M, Rang Saskia, Wolf Hans
Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
Hypertens Pregnancy. 2006;25(3):143-57. doi: 10.1080/10641950600912927.
To evaluate whether sympathetic activity is increased in early-onset hypertensive pregnancy and whether this can be influenced by management with plasma volume expansion.
The study group consisted of 74 subjects, of which 37 had early-onset hypertensive disorders of pregnancy (preeclampsia or gestational hypertension with fetal growth restriction), who were included at 24 to 34 weeks in a randomized controlled trial of management with (n = 18) or without (n = 19) plasma volume expansion. Heart rate and blood pressure variabilities, LF/HF ratio for heart rate, baroreflex sensitivity, and phase difference at low frequency (LF approximately 0.1 Hz) were calculated by spectral analysis from continuous heart rate and blood pressure recordings of the finger pulse wave (Portaprestrade mark, TNO). Measurements were performed at inclusion, after 20 to 40 hours and after 65 to 100 hours. The control group consisted of 29 women with a normal pregnancy and 8 women who had late-onset preeclampsia after 34 weeks. Controls were measured at 32 weeks. All controls had a normal blood pressures at that time.
LF variability of heart rate and blood pressure were significantly higher and baroreflex sensitivity was significantly lower in early-onset patients compared with normal controls. A significant trend towards higher LF variability of blood pressure and lower baroreflex sensitivity was found from normal controls to late-onset controls to early-onset patients. Parameters of sympathetic activity were not influenced by plasma volume expansion.
Sympathetic activity was increased in early-onset hypertensive pregnancy. However, this was not affected by management with plasma volume expansion, suggesting that hypovolaemia in preeclampsia is a secondary phenomenon.
评估早发型高血压妊娠中交感神经活动是否增加，以及血浆容量扩充治疗能否对其产生影响。
研究组由74名受试者组成，其中37例患有早发型妊娠高血压疾病（子痫前期或伴有胎儿生长受限的妊娠期高血压），她们在24至34周时被纳入一项随机对照试验，其中18例接受血浆容量扩充治疗，19例未接受。通过对指脉搏波（Portaprestrade商标，TNO）的连续心率和血压记录进行频谱分析，计算心率和血压变异性、心率的低频/高频比值、压力反射敏感性以及低频（约0.1赫兹）处的相位差。在入组时、20至40小时后以及65至100小时后进行测量。对照组由29名正常妊娠女性和8名34周后发生晚发型子痫前期的女性组成。对照组在32周时进行测量。当时所有对照组血压均正常。
与正常对照组相比，早发型患者的心率和血压低频变异性显著更高，压力反射敏感性显著更低。从正常对照组到晚发型对照组再到早发型患者，发现血压低频变异性升高和压力反射敏感性降低的显著趋势。交感神经活动参数不受血浆容量扩充的影响。
早发型高血压妊娠中交感神经活动增加。然而，这不受血浆容量扩充治疗的影响，提示子痫前期的血容量减少是一种继发现象。
