Suzuki Hiromichi, Watanabe Yusuke, Arima Hiroshi, Kobayashi Kazuhiro, Ohno Yoichi, Kanno Yoshihiko
Department of Nephrology, School of Medicine, Faculty of Medicine, Saitama Medical University, 38 Morohongo Moroyama, Iruma, Saitama, 350-0495, Japan.
Clin Exp Nephrol. 2008 Apr;12(2):102-109. doi: 10.1007/s10157-007-0018-1. Epub 2008 Jan 8.
Little research has been conducted into the long-term effects of preeclampsia, despite its frequent occurrence. The aim of this review is to examine the association between preeclampsia and the development of hypertension and kidney diseases later in life. To achieve this aim, we evaluated three retrospective studies conducted in our department. In the first study, 52 women who suffered from preeclampsia during their first pregnancy were followed for 2 years after delivery for any long-term effects upon blood pressure. In the second study, we evaluated HOMA-R, pulse wave velocity and augmentation index in groups of 48 postmenopausal women with a past history of preeclampsia and 204 postmenopausal women without a past history of preeclampsia. In the third study, we examined the association between a past history of preeclampsia and chronic kidney disease based on biopsy in 127 postmenopausal women. From the first study, although there were no significant differences in age, blood pressure at the onset of preeclampsia, the levels of proteinuria and the birth weight of the child between women who remained hypertensive and those who became normotensive, body mass index was significantly larger in women who remained hypertensive compared to those who were normotensive. In the second study, we found that women with a past history of preeclampsia exhibited insulin resistance combined with reduced vascular elasticity. In the third study, of 32 patients with a past history of preeclampsia, 12 patients exhibited focal segmental glomerulosclerosis, 10 exhibited IgA nephropathy and 10 exhibited nephrosclerosis. In contrast, of the women without a past history of preeclampsia, 26 patients exhibited IgA nephropathy, 20 exhibited a minimal change in nephritic syndrome, 6 exhibited nephrosclerosis, 6 exhibited membranous nephropathy, 5 exhibited lupus nephritis, 5 exhibited diabetic nephropathy, and 27 exhibited various nephropathies. None of the women without a past history of preeclampsia exhibited focal segmental glomerulosclerosis. Taken together with previous results, these findings suggest that hypertension and chronic kidney disease in postmenopausal women are closely associated with a past history of preeclampsia.
尽管先兆子痫频繁发生，但对其长期影响的研究却很少。本综述的目的是研究先兆子痫与晚年高血压和肾脏疾病发展之间的关联。为实现这一目标，我们评估了在本部门进行的三项回顾性研究。在第一项研究中，对52名在首次怀孕时患先兆子痫的女性在分娩后进行了2年的随访，以观察对血压的任何长期影响。在第二项研究中，我们评估了48名有先兆子痫病史的绝经后女性和204名无先兆子痫病史的绝经后女性组中的胰岛素抵抗指数（HOMA-R）、脉搏波速度和增强指数。在第三项研究中，我们基于127名绝经后女性的活检检查了先兆子痫病史与慢性肾病之间的关联。在第一项研究中，尽管在年龄、先兆子痫发作时的血压、蛋白尿水平和婴儿出生体重方面，持续高血压的女性与血压恢复正常的女性之间没有显著差异，但持续高血压的女性的体重指数明显高于血压恢复正常的女性。在第二项研究中，我们发现有先兆子痫病史的女性表现出胰岛素抵抗并伴有血管弹性降低。在第三项研究中，在32名有先兆子痫病史的患者中，12名患者表现为局灶节段性肾小球硬化，10名表现为IgA肾病，10名表现为肾硬化。相比之下，在无先兆子痫病史的女性中，26名患者表现为IgA肾病，20名表现为轻微病变性肾病综合征，6名表现为肾硬化，6名表现为膜性肾病，5名表现为狼疮性肾炎，5名表现为糖尿病肾病，27名表现为各种肾病。无先兆子痫病史的女性中没有一人表现出局灶节段性肾小球硬化。综合先前的研究结果，这些发现表明绝经后女性的高血压和慢性肾病与先兆子痫病史密切相关。
