Bouchlariotou Sofia, Liakopoulos Vassilios, Dovas Spiros, Giannopoulou Myrto, Kiropoulos Theodoros, Zarogiannis Sotirios, Gatselos Georgios, Zachopoulos Thomas, Kyriakou Despina S, Kallitsaris Athanasios, Messinis Ioannis, Stefanidis Ioannis
Department of Nephrology, School of Medicine, University of Thessaly, Larissa, Greece.
Am J Nephrol. 2008;28(3):424-30. doi: 10.1159/000112807. Epub 2007 Dec 20.
Non-dipping pattern of circadian blood pressure in preeclampsia is associated with an increased risk of cardiovascular disease. The pathogenetic mechanisms of this relationship are still unclear. We investigated whether non-dipping in preeclampsia could relate to endothelial activation or damage.
Participants, 20 women with normal pregnancy (mean age 29.9 +/- 5.7 years) and 31 women with preeclampsia (mean age 29.1 +/- 5.1 years), underwent 24-hour ambulatory blood pressure monitoring. Plasma levels of von Willebrand factor (vWf), marker of endothelial damage and of soluble adhesion molecules (sVCAM-1, sICAM-1), and markers of endothelial activation were determined using commercially available enzyme-linked immunoassays.
Based on whether the nocturnal mean arterial pressure (MAP) relative to the daytime MAP declined by less than 10%, 21 women with preeclampsia were categorized as non-dippers. Compared to healthy pregnant women, patients with preeclampsia showed significantly enhanced levels of vWf (206.9 +/- 40.6 vs. 123 +/- 24 IU/dl;p<0.01) and sVCAM-1 (2,269 +/- 426 vs.1,159.8 +/- 340 ng/ml; p < 0.01). In addition, significantly higher levels of vWf (224.5 +/- 34.9 vs. 170 +/- 23 IU/dl; p < 0.01) and sVCAM-1 (2,405 +/- 421.4 vs. 1,983 +/- 276.7 ng/ml; p = 0.007) were determined, when women with preeclampsia and nocturnal hypertension (non-dippers) were compared to dippers. The results were similar even after adjustment for severity of preeclampsia. In contrast, neither preeclampsia nor dipping status had an effect on sICAM-1 levels.
Nocturnal hypertension in preeclampsia is associated with elevated levels of molecules related to endothelial damage. Endothelial damage is a recognized pathogenetic factor for atherosclerosis and history of preeclampsia is a risk factor for cardiovascular disease. In this context, possible clinical implications of our findings deserve further investigation.
子痫前期患者昼夜血压的非勺型模式与心血管疾病风险增加相关。这种关系的发病机制仍不清楚。我们研究了子痫前期患者的血压非勺型模式是否与内皮激活或损伤有关。
20名正常妊娠女性（平均年龄29.9±5.7岁）和31名子痫前期女性（平均年龄29.1±5.1岁）参与了24小时动态血压监测。使用市售酶联免疫分析法测定血管性血友病因子（vWf）（内皮损伤标志物）、可溶性黏附分子（sVCAM-1、sICAM-1）（内皮激活标志物）的血浆水平。
根据夜间平均动脉压（MAP）相对于日间MAP下降是否小于10%，将21名子痫前期女性归类为非勺型血压者。与健康孕妇相比，子痫前期患者的vWf水平（206.9±40.6 vs. 123±24 IU/dl；p<0.01）和sVCAM-1水平（2269±426 vs. 1159.8±340 ng/ml；p<0.01）显著升高。此外，将子痫前期伴夜间高血压（非勺型血压者）的女性与勺型血压者相比，vWf水平（224.5±34.9 vs. 170±23 IU/dl；p<0.01）和sVCAM-1水平（2405±421.4 vs. 1983±276.7 ng/ml；p = 0.007）也显著更高。即使在调整子痫前期严重程度后，结果仍相似。相比之下，子痫前期和勺型血压状态对sICAM-1水平均无影响。
子痫前期患者的夜间高血压与内皮损伤相关分子水平升高有关。内皮损伤是动脉粥样硬化公认的发病因素，子痫前期病史是心血管疾病的危险因素。在此背景下，我们研究结果可能的临床意义值得进一步研究。
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