Section of Nephrology, Department of Pediatrics, Rush University Medical Center, 1725 West Harrison Street, Suite 718 Professional Bldg, Chicago, IL, USA.
Pediatr Nephrol. 2011 Mar;26(3):469-71. doi: 10.1007/s00467-010-1700-1. Epub 2010 Nov 27.
Although there are clinical data suggesting a direct relationship between neonatal nephrotic syndrome and placental transfer of proinflammatory cytokines from mothers with HELLP syndrome, there is no direct evidence that these inflammatory cytokines are pathogenic. Here, the first human model of placental transfer of proinflammatory cytokines from a mother with HELLP syndrome to a newborn, resulting in neonatal nephrotic syndrome is described. Forty-eight hours after delivery, the neonate developed nephrotic syndrome and abnormalities in renal function which resolved completely during the 5 days following the initiation of therapy with hydrocortisone, albumin, and furosemide. The newborn's cord blood showed increased concentrations of interleukin (IL)-1β, IL-6, and tumor necrosis factor alpha that were identical to those found in the mother's serum. Hydrocortisone therapy was discontinued after a 2-week course. Clinical and laboratory improvements were associated with a marked decline in serum cytokine levels, indicating that the proinflammatory cytokines were pathogenic. The neonate remained in remission with no recurrence of nephrotic syndrome during 12 months of follow-up. These findings demonstrate that the placental transmission of circulating cytokines causing HELLP syndrome occurred during pregnancy and may have resulted in nephrotic syndrome in the neonate.
尽管有临床数据表明新生儿肾病综合征与母体 HELLP 综合征产生的促炎细胞因子经胎盘转移直接相关，但尚无直接证据表明这些炎症细胞因子是致病的。在此，我们首次描述了母体 HELLP 综合征产生的促炎细胞因子经胎盘转移至新生儿，导致新生儿肾病综合征的人类模型。新生儿在出生后 48 小时出现肾病综合征和肾功能异常，在开始使用氢化可的松、白蛋白和呋塞米治疗的 5 天内完全缓解。新生儿脐带血中白细胞介素（IL）-1β、IL-6 和肿瘤坏死因子-α的浓度增加，与母亲血清中的浓度相同。在经过 2 周的疗程后，停止使用氢化可的松治疗。临床和实验室的改善与血清细胞因子水平的显著下降相关，表明这些促炎细胞因子是致病的。在 12 个月的随访期间，新生儿未复发肾病综合征，一直处于缓解状态。这些发现表明，导致 HELLP 综合征的循环细胞因子在怀孕期间经胎盘传递，并可能导致新生儿肾病综合征。
