Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
J Hum Hypertens. 2013 Feb;27(2):115-8. doi: 10.1038/jhh.2012.1. Epub 2012 Feb 16.
This study is aimed to determine whether the maternal serum levels of vitamin D in the first trimester of pregnancy are altered in cases that develop preeclampsia (PE) and whether the levels are related to biochemical and biophysical markers of impaired placental perfusion and function. Maternal total serum vitamin D, pregnancy-associated plasma protein-A (PAPP-A), uterine artery pulsatility index (PI) and mean arterial pressure (MAP) were measured at 11-13 week gestation in 90 cases that developed PE, including 30 that required delivery before 34 weeks (early PE) and 1000 unaffected controls. The median values of vitamin D, PAPP-A, uterine artery PI and MAP expressed as a multiple of the unaffected median (MoM), in the patients developing early PE and late PE were compared with the controls. There was no significant difference in the median serum vitamin D MoM or raw values within the outcome groups (P=141 and P=0.231, respectively) whereas the median PAPP-A MoM, uterine PI MoM and MAP MoM were significantly different (P=0.031, P=0.001 and P<0.0001, respectively). Serum PAPP-A was decreased in both early PE and late PE (0.54 and 0.88 versus 1.03 MoM, P<0.0001 and P=0.010, respectively), MAP was increased in both early PE and late PE (1.09 and 1.06 versus 0.99 MoM, P<0.0001 and P<0.0001, respectively) and uterine artery PI was increased in early PE but not in late PE (1.32 and 1.12 versus 1.01 MoM, P<0.0001 and P=0.083, respectively). In pregnancies that subsequently develop PE maternal serum total vitamin D levels at 11-13 weeks are not altered.
本研究旨在确定妊娠早期母体血清维生素 D 水平是否在发生子痫前期 (PE) 的病例中发生改变，以及这些水平是否与胎盘灌注和功能受损的生化和生物物理标志物有关。在 90 例发生 PE 的病例中，包括 30 例需要在 34 周前分娩的病例（早期 PE）和 1000 例未受影响的对照组，在 11-13 周妊娠时测量了母体总血清维生素 D、妊娠相关血浆蛋白-A (PAPP-A)、子宫动脉搏动指数 (PI) 和平均动脉压 (MAP)。比较了发生早期 PE 和晚期 PE 的患者与对照组的维生素 D、PAPP-A、子宫动脉 PI 和 MAP 的中位数倍数 (MoM) 值。在结局组内，血清维生素 D MoM 或原始值的中位数没有显著差异（P=141 和 P=0.231，分别），而 PAPP-A MoM、子宫 PI MoM 和 MAP MoM 的中位数则有显著差异（P=0.031、P=0.001 和 P<0.0001，分别）。早期 PE 和晚期 PE 中血清 PAPP-A 均降低（0.54 和 0.88 与 1.03 MoM 相比，P<0.0001 和 P=0.010，分别），MAP 在早期 PE 和晚期 PE 中均升高（1.09 和 1.06 与 0.99 MoM 相比，P<0.0001 和 P<0.0001，分别），而子宫动脉 PI 在早期 PE 中升高但在晚期 PE 中没有升高（1.32 和 1.12 与 1.01 MoM 相比，P<0.0001 和 P=0.083，分别）。在随后发生 PE 的妊娠中，11-13 周时母体血清总维生素 D 水平并未改变。
