Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Center, A139, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5.
J Clin Endocrinol Metab. 2011 Nov;96(11):3517-24. doi: 10.1210/jc.2011-1125. Epub 2011 Aug 31.
Women with a history of severe preeclampsia are at an increased risk for the development of vascular disease.
We hypothesized that abnormalities in the renin-angiotensin system (RAS) may be a predisposing factor.
Physiological assessments were conducted at an academic center.
Sixteen women with previous severe preeclampsia (PPE) were compared with nine previously pregnant controls (PPC) and 11 never-pregnant controls (NPC).
Baseline circulating components of the RAS and expression of angiotensin (ANG) II type I (AT1) and type II (AT2) receptors in the skin were assessed along with the response to simulated orthostatic stress using incremental lower-body negative pressure (LBNP: -15, -25, and -40 mm Hg) and a graded ANG II infusion (1 and 3 ng/kg · min).
Response to LBNP and ANG II was evaluated.
RAS components were not different between previously pregnant groups, but were decreased compared with NPC subjects. In response to LBNP, there were significant increases in RAS components in all three groups, but the response to this stimulus was significantly lower and delayed in PPE subjects. Despite the blunted rise in circulating RAS mediators in PPE subjects, their blood pressure was maintained in 88% compared with only 33 and 55% in the PPC and NPC groups, respectively (P = 0.014). All three groups responded to the graded ANG II infusion with an increase in blood pressure that was significantly more pronounced in PPE subjects (P = 0.037) correlating with AT1/AT2 receptor expression.
Alterations in the RAS in formerly preeclamptic patients may contribute to future vascular disease.
有严重先兆子痫病史的女性发生血管疾病的风险增加。
我们假设肾素-血管紧张素系统（RAS）的异常可能是一个促成因素。
在学术中心进行生理评估。
将 16 名有既往重度先兆子痫（PPE）的女性与 9 名既往妊娠对照组（PPC）和 11 名从未妊娠对照组（NPC）进行比较。
评估 RAS 的基线循环成分以及皮肤中血管紧张素（ANG）II 型 1（AT1）和 2（AT2）受体的表达，并使用增量下体负压（LBNP：-15、-25 和-40mmHg）和分级 ANG II 输注（1 和 3ng/kg·min）模拟直立应激反应。
评估 LBNP 和 ANG II 的反应。
RAS 成分在既往妊娠组之间没有差异，但与 NPC 组相比有所降低。在 LBNP 作用下，所有三组的 RAS 成分都有明显增加，但 PPE 组对此刺激的反应明显较低且延迟。尽管 PPE 组循环 RAS 介质的升高幅度较低，但她们的血压维持在 88%，而 PPC 和 NPC 组分别仅维持在 33%和 55%（P=0.014）。三组均对分级 ANG II 输注有血压升高反应，PPE 组的反应明显更明显（P=0.037），与 AT1/AT2 受体表达相关。
既往子痫前期患者 RAS 的改变可能导致未来的血管疾病。
