Department of Fetal Medicine, Institute for Women's Health, University College London Hospitals, London, UK.
J Hum Hypertens. 2013 Jan;27(1):38-43. doi: 10.1038/jhh.2011.109. Epub 2011 Dec 8.
The aim of this study was to investigate whether the nitric oxide (NO) pathway is altered in pregnancies that develop preeclampsia (PE). This was a nested case-control study of screening for PE, in which plasma asymmetric dimethylarginine (ADMA), L-arginine and L-homoarginine were measured at 11(+0)-13(+6) weeks. In all, 75 pregnancies that developed PE, including 25 requiring delivery before 34 weeks (early PE), and 300 unaffected controls were included. L-arginine and L-homoarginine were measured by gas chromatography-mass spectrometry, whereas ADMA was measured by gas chromatography-tandem mass spectrometry. Multiple regression analysis was used to determine if any maternal characteristics or gestation were significant predictors. In the early-PE group, both L-arginine and L-homoarginine expected medians (MoMs) were significantly reduced (median, IQR: 0.85, 0.76-1.04 vs 0.98, 0.88-1.16, P=0.021 and 0.78, 0.65-0.96 vs 0.99, 0.77-1.31, P=0.006, respectively) but ADMA MoMs were not significantly different (P=0.599). In early PE, compared with controls, the ratios of ADMA to L-arginine MoMs and ADMA to L-homoarginine MoMs were increased (median, IQR: 1.19, 0.94-1.33 vs 1.01, 0.75-1.31, P=0.003 and 1.21, 0.93-1.61 vs 0.99, 0.87-1.16, P=0.012, respectively). There were no significant differences between late PE and controls in ADMA, L-arginine, L-homoarginine or their ratios. In conclusion, development of early PE is associated with altered NO metabolism and/or synthesis apparent from the first trimester.
本研究旨在探讨一氧化氮（NO）通路是否在发生子痫前期（PE）的妊娠中发生改变。这是一项关于 PE 筛查的嵌套病例对照研究，其中在 11（+0）-13（+6）周时测量血浆不对称二甲基精氨酸（ADMA）、L-精氨酸和 L-同型精氨酸。共纳入 75 例发生 PE 的妊娠，其中 25 例在 34 周前分娩（早期 PE），300 例未受影响的对照组。通过气相色谱-质谱法测量 L-精氨酸和 L-同型精氨酸，通过气相色谱-串联质谱法测量 ADMA。多元回归分析用于确定任何母体特征或妊娠是否是显著的预测因子。在早期 PE 组中，L-精氨酸和 L-同型精氨酸的预期中位数（MoM）均显著降低（中位数，IQR：0.85，0.76-1.04 与 0.98，0.88-1.16，P=0.021 和 0.78，0.65-0.96 与 0.99，0.77-1.31，P=0.006），但 ADMA MoM 无显著差异（P=0.599）。与对照组相比，在早期 PE 中，ADMA 与 L-精氨酸 MoM 的比值和 ADMA 与 L-同型精氨酸 MoM 的比值升高（中位数，IQR：1.19，0.94-1.33 与 1.01，0.75-1.31，P=0.003 和 1.21，0.93-1.61 与 0.99，0.87-1.16，P=0.012）。晚期 PE 与对照组在 ADMA、L-精氨酸、L-同型精氨酸及其比值方面均无显著差异。结论：从第一孕期开始，早期 PE 的发生与明显的一氧化氮代谢和/或合成改变有关。
