患有重度子痫前期的女性在产前和产后接受硫酸镁治疗期间的前列环素和血栓素水平。
Prostacyclin and thromboxane levels in women with severe preeclampsia undergoing magnesium sulfate therapy during antepartum and postpartum periods.
作者信息
Wang Yuping, Zhang Yanping, Canzoneri Bernard J, Gu Yang, Philibert Lisa, Lewis David F
机构信息
Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, LA 70030, USA.
出版信息
Hypertens Pregnancy. 2008;27(1):17-27. doi: 10.1080/10641950701825721.
OBJECTIVE
To study effects of magnesium sulfate (MgSO(4)) on prostacyclin (PGI(2)) and thromboxane A(2) (TXA(2)) levels in women with severe preeclampsia during antepartum and postpartum periods.
METHODS
Women with severe preeclampsia were randomized into two groups. Patients in Group A were continuously infused with MgSO(4) for 24 hours postpartum. In Group B, MgSO(4) administration was discontinued when urinary output was of > or =100 ml/hr for 2 consecutive hours. Patient demographic data were collected. Venous blood was drawn at time of MgSO(4) administration and 24 hours after delivery. Plasma levels of 6-keto-PGF1alpha and TXB(2), stable metabolites of PGI(2) and TXA(2), were measured by enzyme-linked immunosorbent assay (ELISA). Data are presented as mean +/- SE, and analyzed by paired t-test.
RESULTS
A total of 50 patients were recruited, with 27 in Group A and 23 in Group B. There were no statistical differences for demographic data between the two groups with regards to maternal age; gestational age; systolic and diastolic blood pressures at admission, 12 hours postpartum, and 24 hours postpartum; and mode of delivery. Platelet counts were all within the normal range at the time of enrollment. MgSO(4) was administered for an average of 10 hours postpartum in Group B. Maternal blood pressures returned to normal or close to normal levels in both groups at 24 hours postpartum. 6-keto PGF1alpha levels were significantly decreased 24 hours after delivery compared with the levels at enrollment in both groups, (Group A: 98 +/- 13 vs. 180 +/- 28 pg/mL; Group B: 142 + 17 vs. 194 +/- 31 pg/mL, p < 0.05, respectively). However, there was no difference detected between the two groups. TXB(2) levels were not different between group A and Group B at the time of enrollment, 38 +/- 9 vs. 33 +/- 8 pg/mL, and 24 hours postpartum, 26 +/- 5 vs. 25 +/- 3 pg/mL, respectively.
CONCLUSIONS
Administration of MgSO(4) does not affect prostacyclin and thromboxane levels in the maternal circulation in women with preeclampsia during antepartum and postpartum periods. We speculate that a higher level of prostacyclin before delivery may reflect compensatory effects of this vasodilator to offset increased maternal blood pressure during pregnancy.
目的
研究硫酸镁（MgSO₄）对重度子痫前期妇女产前及产后前列环素（PGI₂）和血栓素A₂（TXA₂）水平的影响。
方法
将重度子痫前期妇女随机分为两组。A组患者产后连续输注MgSO₄ 24小时。B组当尿量连续2小时≥100 ml/小时后停止输注MgSO₄。收集患者人口统计学数据。在输注MgSO₄时及分娩后24小时采集静脉血。采用酶联免疫吸附测定（ELISA）法检测PGI₂和TXA₂的稳定代谢产物6-酮-前列腺素F1α（6-keto-PGF1α）和血栓素B₂（TXB₂）的血浆水平。数据以均数±标准误表示，采用配对t检验进行分析。
结果
共招募50例患者，A组27例，B组23例。两组在产妇年龄、孕周、入院时及产后12小时和24小时的收缩压和舒张压以及分娩方式等人口统计学数据方面无统计学差异。入组时血小板计数均在正常范围内。B组产后MgSO₄平均输注10小时。两组产妇产后24小时血压均恢复至正常或接近正常水平。两组分娩后24小时6-酮-前列腺素F1α水平均较入组时显著降低（A组：98±13 vs. 180±28 pg/mL；B组：142±17 vs. 194±31 pg/mL，p均<0.05）。然而，两组之间未检测到差异。A组和B组入组时TXB₂水平分别为38±9 vs. 33±8 pg/mL，产后24小时分别为26±5 vs. 25±3 pg/mL，两组之间无差异。
结论
硫酸镁的使用在产前及产后均不影响子痫前期妇女母体循环中的前列环素和血栓素水平。我们推测分娩前较高水平的前列环素可能反映了这种血管舒张剂的代偿作用，以抵消孕期母体血压的升高。
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