de Oliveira Leandro Gustavo, Karumanchi Ananth, Sass Nelson
Departamento de Obstetrícia, Universidade Federal de São Paulo, São Paulo, Brasil.
Rev Bras Ginecol Obstet. 2010 Dec;32(12):609-16. doi: 10.1590/s0100-72032010001200008.
Preeclampsia is a systemic syndrome characterized by inflammatory and antiangiogenic states. The pathogenesis of preeclampsia involves deficient trophoblast invasion that is responsible for altered uterine blood flow and placental oxidative stress. The damaged placenta produces higher concentrations of sFlt-1, a soluble receptor for VEGF and PlGF that is released in the maternal circulation and is involved in endothelial dysfunction. Actually, all processes involved in inflammation, endothelial dysfunction and oxidative stress are strongly correlated and act in a synergistic way. Recent data have shown that an increase in serum concentrations of sFlt-1 initiates 5 to 6 weeks before the clinical manifestations of preeclampsia and these alterations correlate with a decrease in serum concentrations of PlGF. Therefore, both sFlt-1 and PlGF have been suggested to be useful for an early-diagnosis of preeclampsia. The knowledge about the role of antiangiogenic factors in the pathogenesis of preeclampsia has raised the possibility of a therapy involving these factors.In this article we revisited the pathogenesis of preeclampsia addressing its antiangiogenic and inflammatory states.In conclusion, we correlated these alterations with the higher risk for cardiovascular diseases presented by these women in future life.
子痫前期是一种以炎症和抗血管生成状态为特征的全身性综合征。子痫前期的发病机制涉及滋养层细胞浸润不足,这导致子宫血流改变和胎盘氧化应激。受损的胎盘会产生更高浓度的sFlt-1,它是VEGF和PlGF的可溶性受体,释放入母体循环并参与内皮功能障碍。实际上,炎症、内皮功能障碍和氧化应激所涉及的所有过程都密切相关且协同作用。最近的数据表明,sFlt-1血清浓度升高在子痫前期临床表现出现前5至6周就已开始,且这些改变与PlGF血清浓度降低相关。因此,sFlt-1和PlGF都被认为对子痫前期的早期诊断有用。关于抗血管生成因子在子痫前期发病机制中的作用的知识增加了针对这些因子进行治疗的可能性。在本文中,我们重新审视了子痫前期的发病机制,探讨了其抗血管生成和炎症状态。总之,我们将这些改变与这些女性未来生活中患心血管疾病的较高风险相关联。