Unidad Clínico-Experimental de Riesgo Vascular (UCERV-UCAMI del Servicio de Medicina Interna) y Unidad de Gestion de los Laboratorios Clínicos, Instituto de Biomedicina de Sevilla (IbiS), Hospital Universitario Virgen del Rocío, SAS, Universidad de Sevilla, CSIC, Sevilla, Spain.
Am J Hypertens. 2013 Dec;26(12):1377-80. doi: 10.1093/ajh/hpt187. Epub 2013 Oct 8.
Increased plasma levels of circulating cell-free DNA (c-f DNA) have been recently described in diseases related to ischemia and/or hypoxia. Preeclampsia (PCL) is a hypertensive disorder of pregnancy, of unknown origin, where a defective placentation resulting in placental ischemia plays an important role. HELLP syndrome (haemolysis, elevated liver enzymes, and low platelet count) is the most serious form of PCL. The origin of the disease is unknown, and there are no markers to help us to make an early diagnosis of disease or to predict patients who are at risk of suffering serious complications.
We measured circulating c-f DNA levels in a group of control pregnant women (n = 20), patients with mild PCL (n = 9), patients with severe PCL (n = 24), and patients with HELLP syndrome (n = 8).
Values of circulating c-f DNA were 333.59 ± 64.3 ng/ml in control subjects; 635.11 ± 111.7 ng/ml in patients with mild PCL; 1,264.63 ± 127.1 ng/ml in patients with severe PCL, and 1,595.95 ± 269.8 ng/ml in patients with HELPP syndrome. (P < 0.0001). Values of c-f DNA >950 ng/ml had a sensitivity and specificity for detecting severe PCL and/or HELLLP syndrome of 0.71 and 0.93, respectively.
As far as we know, this is the first report of increased c-f DNA levels in HELLP syndrome. In this preliminary report, we have observed a gradual and strong relation between c-f DNA levels and range of severity of PCL, with it the highest in patients with HELLP syndrome. Further studies are needed for evaluating the utility of this technique in hypertensive disorders of pregnancy and, particularly, in HELLP syndrome.
循环无细胞 DNA（c-f DNA）的血浆水平在与缺血和/或缺氧相关的疾病中最近被描述增加。子痫前期（PCL）是一种妊娠高血压疾病，其病因不明，其中胎盘缺血导致胎盘功能不全起着重要作用。HELLP 综合征（溶血、肝酶升高和血小板计数低）是 PCL 最严重的形式。疾病的起源未知，也没有标记物可以帮助我们早期诊断疾病或预测有发生严重并发症风险的患者。
我们测量了一组对照组孕妇（n=20）、轻度 PCL 患者（n=9）、重度 PCL 患者（n=24）和 HELLP 综合征患者（n=8）的循环 c-f DNA 水平。
对照组循环 c-f DNA 值为 333.59±64.3ng/ml；轻度 PCL 患者为 635.11±111.7ng/ml；重度 PCL 患者为 1264.63±127.1ng/ml；HELLP 综合征患者为 1595.95±269.8ng/ml。（P<0.0001）。c-f DNA 值>950ng/ml 对重度 PCL 和/或 HELLLP 综合征的敏感性和特异性分别为 0.71 和 0.93。
据我们所知，这是首次报道 HELLP 综合征中 c-f DNA 水平增加。在这项初步报告中，我们观察到 c-f DNA 水平与 PCL 严重程度之间存在逐渐且强烈的关系，HELLP 综合征患者的水平最高。需要进一步研究来评估该技术在妊娠高血压疾病中的应用价值，特别是在 HELLP 综合征中。
