Clinic of Anesthesiology, Ludwig-Maximilians University, City of Munich, München, Germany.
Reprod Sci. 2013 Mar;20(3):318-25. doi: 10.1177/1933719112453508. Epub 2012 Aug 7.
Severe inflammation has been shown to induce a shedding of the endothelial glycocalyx (EGX). Inflammatory cytokines, such as tumor necrosis factor α (TNF-α), impede the thickness of the EGX. While a controlled inflammatory reaction occurs already in normal pregnancy, women with hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome had an exaggerated inflammatory response. This study investigates the shedding of the glycocalyx during normal pregnancy and in women with HELLP syndrome. Glycocalyx components (syndecan 1, heparan sulfate, and hyaluronic acid) were measured in serum of healthy women throughout pregnancy (4 time points, n = 26), in women with HELLP syndrome (n = 17) before delivery and in nonpregnant volunteers (n = 10). Serum concentrations of TNF-α and soluble TNF-α receptors (sTNF-Rs) were assessed once in all 3 groups. Syndecan 1 serum concentrations constantly rose throughout normal pregnancy. Immediately before delivery, a 159-fold increase was measured compared to nonpregnant controls (P < .01). Even higher amounts were observed in patients with HELLP prior to delivery (median 12 252 ng/mL) compared to healthy women matched by gestational age (median 5943 ng/mL; P < .01). Relevantly, increased serum levels of heparan sulfate, hyaluronic acid, and sTNF-Rs were only detected in patients with HELLP (P < .01). These findings suggest that considerable amounts of syndecan 1 are released into maternal blood during uncomplicated pregnancy. The HELLP syndrome is associated with an even more pronounced shedding of glycocalyx components. The maternal vasculature as well as the placenta has to be discussed as a possible origin of circulating glycocalyx components.
严重的炎症已被证明会导致内皮糖萼（EGX）脱落。炎性细胞因子，如肿瘤坏死因子-α（TNF-α），会阻碍 EGX 的厚度。虽然正常妊娠已经发生了受控的炎症反应，但患有溶血、肝酶升高和血小板减少（HELLP）综合征的女性则出现了过度的炎症反应。本研究调查了正常妊娠和 HELLP 综合征妇女中糖萼的脱落情况。在整个妊娠期间（4 个时间点，n=26），在分娩前的 HELLP 综合征妇女（n=17）和非妊娠志愿者（n=10）的血清中测量了糖萼成分（连接蛋白 1、硫酸乙酰肝素和透明质酸）。在所有 3 组中均评估了 TNF-α和可溶性 TNF-α受体（sTNF-R）的血清浓度。在整个正常妊娠期间，连接蛋白 1 的血清浓度持续升高。与非妊娠对照组相比，分娩前的浓度增加了 159 倍（P<.01）。在 HELLP 患者中，甚至观察到更高的浓度（中位数 12252ng/mL），与按胎龄匹配的健康女性相比（中位数 5943ng/mL；P<.01）。相关地，仅在 HELLP 患者中检测到肝素硫酸、透明质酸和 sTNF-R 的血清水平升高（P<.01）。这些发现表明，在无并发症的妊娠期间，大量的连接蛋白 1 被释放到母体血液中。HELLP 综合征与糖萼成分更明显的脱落有关。母体血管系统以及胎盘都可能是循环糖萼成分的来源。
