Alma Lisa J, Bokslag Anouk, Maas Angela H E M, Franx Arie, Paulus Walter J, de Groot Christianne J M
Department of Obstetrics and GynecologyVU University Medical CenterAmsterdamThe Netherlands.
Department of CardiologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands.
ESC Heart Fail. 2017 May;4(2):88-98. doi: 10.1002/ehf2.12129. Epub 2017 Jan 30.
Evidence accumulates for associations between hypertensive pregnancy disorders and increased cardiovascular risk later. The main goal of this study was to explore shared biomarkers representing common pathogenic pathways between heart failure with preserved ejection fraction (HFpEF) and pre-eclampsia where these biomarkers might be potentially eligible for cardiovascular risk stratification in women after hypertensive pregnancy disorders. We sought for blood markers in women with diastolic dysfunction in a first literature search, and through a second search, we investigated whether these same biochemical markers were present in pre-eclampsia.This systematic review and meta-analysis presents two subsequent systematic searches in PubMed and EMBASE. Search I yielded 3014 studies on biomarkers discriminating women with HFpEF from female controls, of which 13 studies on 11 biochemical markers were included. Cases had HFpEF, and controls had no heart failure. The second search was for studies discriminating women with pre-eclampsia from women with non-hypertensive pregnancies with at least one of the biomarkers found in Search I. Search II yielded 1869 studies, of which 51 studies on seven biomarkers were included in meta-analyses and 79 studies on 12 biomarkers in systematic review.Eleven biological markers differentiated women with diastolic dysfunction from controls, of which the following 10 markers differentiated women with pre-eclampsia from controls as well: C-reactive protein, HDL, insulin, fatty acid-binding protein 4, brain natriuretic peptide, N terminal pro brain natriuretic peptide, adrenomedullin, mid-region pro adrenomedullin, cardiac troponin I, and cancer antigen 125.Our study supports the hypothesis that HFpEF in women shares a common pathogenic background with pre-eclampsia. The biomarkers representing inflammatory state, disturbances in myocardial function/structure, and unfavourable lipid metabolism may possibly be eligible for future prognostic tools.
越来越多的证据表明，妊娠期高血压疾病与日后心血管疾病风险增加之间存在关联。本研究的主要目的是探索能代表射血分数保留的心力衰竭（HFpEF）和子痫前期共同致病途径的共享生物标志物，这些生物标志物可能有助于对患有妊娠期高血压疾病的女性进行心血管疾病风险分层。在首次文献检索中，我们在患有舒张功能障碍的女性中寻找血液标志物，通过第二次检索，我们研究了子痫前期患者是否也存在这些相同的生化标志物。本系统评价和荟萃分析在PubMed和EMBASE数据库中进行了两次后续系统检索。检索一得到了3014项关于鉴别HFpEF女性与女性对照的生物标志物的研究，其中13项关于11种生化标志物的研究被纳入。病例组为HFpEF患者，对照组无心力衰竭。第二次检索是寻找鉴别子痫前期女性与非高血压妊娠女性且至少具有检索一中发现的一种生物标志物的研究。检索二得到了1869项研究，其中51项关于7种生物标志物的研究被纳入荟萃分析，79项关于12种生物标志物的研究被纳入系统评价。11种生物标志物可区分舒张功能障碍女性与对照组，其中以下10种标志物也可区分子痫前期女性与对照组：C反应蛋白、高密度脂蛋白、胰岛素、脂肪酸结合蛋白4、脑钠肽、N末端前脑钠肽、肾上腺髓质素、肾上腺髓质素中段、心肌肌钙蛋白I和癌抗原125。我们的研究支持HFpEF女性与子痫前期具有共同致病背景这一假说。代表炎症状态、心肌功能/结构紊乱和不良脂质代谢的生物标志物可能有望成为未来的预后工具。
