Reddy Aparna, Suri Sangeeta, Sargent Ian L, Redman Christopher W G, Muttukrishna Shanthi
Fetal Medicine Unit, Elizabeth Gareth Anderson Hospital, University College Hospital, London, United Kingdom.
PLoS One. 2009;4(2):e4453. doi: 10.1371/journal.pone.0004453. Epub 2009 Feb 11.
Maternal circulating levels of anti-angiogenic factors such as soluble fms-like tyrosine kinase-1 (sFlt-1), endoglin (sEng) and placental proteins like activin A and inhibin A are increased before the onset of pre-eclampsia. There is evidence for oxidative stress in pre eclampsia. Recently it was shown that placental oxygen concentration is related to sFlt-1 and inhibin A. In addition it is reported that oxidative stress markers are increased in placental tissue delivered after labour. Therefore, the objective of this study is to investigate if these proteins are altered in maternal circulation of labouring pre-eclampsia and normal pregnancies.
To assess the effects of labour, samples were taken from 10 normal pregnant (NP) and 10 pre-eclamptic (PE) women pre-labour, full dilation, placental delivery and 24 h. To assess the effects of placental delivery, plasma samples were taken from 10NP and 10PE women undergoing elective Caesarean section, pre-delivery, placental delivery and 10 min, 60 min and 24 h post delivery. SFlt-1 and sEng and activin A and inhibin A were measured using commercial and in house ELISA's respectively.
The levels of sFlt-1 and sEng were significantly higher in PE compared to NP women in both groups. In labour, sFlt-1 levels increased significantly at full dilatation in PE women, before declining by 24 hr. However there was no significant rise in sEng levels in labour. Activin A and inhibin A levels declined rapidly with placental delivery in NP and PE pregnancies. There was a significant rise in activin A levels during labour in PE compared to pre labour, but inhibin levels did not increase.
Labour in pre-eclamptic women increases the levels of sFlt-1 and activin A. This pilot data suggests that increase in the maternal levels of these factors in labour could predict and/or contribute to the maternal syndrome postpartum.
子痫前期发病前，母体循环中抗血管生成因子如可溶性fms样酪氨酸激酶-1（sFlt-1）、内皮糖蛋白（sEng）以及胎盘蛋白如激活素A和抑制素A的水平会升高。有证据表明子痫前期存在氧化应激。最近研究表明胎盘氧浓度与sFlt-1和抑制素A有关。此外，有报道称分娩后胎盘组织中的氧化应激标志物会升高。因此，本研究的目的是调查这些蛋白质在临产子痫前期和正常妊娠的母体循环中是否发生改变。
为评估分娩的影响，在临产前、宫口全开时、胎盘娩出时及产后24小时，从10名正常妊娠（NP）和10名子痫前期（PE）女性中采集样本。为评估胎盘娩出的影响，在择期剖宫产的10名NP和10名PE女性中，于分娩前、胎盘娩出时及产后10分钟、60分钟和24小时采集血浆样本。分别使用商业酶联免疫吸附测定法（ELISA）和内部ELISA法测量sFlt-1、sEng、激活素A和抑制素A。
在两组中，PE女性的sFlt-1和sEng水平均显著高于NP女性。在分娩过程中，PE女性宫口全开时sFlt-1水平显著升高，随后在24小时下降。然而，分娩过程中sEng水平无显著升高。在NP和PE妊娠中，胎盘娩出后激活素A和抑制素A水平迅速下降。与临产前相比，PE妊娠分娩过程中激活素A水平显著升高，但抑制素水平未升高。
子痫前期女性分娩会增加sFlt-1和激活素A的水平。这些初步数据表明，分娩时母体中这些因子水平的升高可能预测和/或导致产后母体综合征。
