a Medical and Clinical Genetics , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.
b Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki, Finland.
Ann Med. 2017 Nov;49(7):593-602. doi: 10.1080/07853890.2017.1335427. Epub 2017 Jun 9.
The biological mechanism by which smoking reduces the risk of pre-eclampsia (PE) is unresolved. We studied serum levels of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF) and their ratio, in addition to soluble endoglin (sEng) in early and late pregnancy to ascertain whether these factors are altered in women who smoke.
First trimester serum samples were available from 217 women who later developed PE and 238 women who did not develop PE. Second/third trimester serum samples were available from 174 PE and 54 non-PE women.
PE women who smoked during pregnancy had elevated first trimester concentrations of serum PlGF [geometric mean (95% CI): 39.8 (32.6-48.5) pg/ml, p = .001] and reduced sEng concentration [5.0 (4.6-5.6) ng/ml, p = .047] compared to PE non-smokers [30.0 (28.1-32.1) pg/ml and 6.1 (5.9-6.4) ng/ml, respectively]. Non-smoking women in the PE group had the highest sFlt-1/PlGF ratio in early and late pregnancy.
The protective effect of smoking in reducing the risk of PE may be due to the early pregnancy change towards pro-angiogenic marker profile. Also, in late pregnancy, smoking exerted effect in sFlt-1/PlGF ratio in PE pregnancies, and may complicate its use as a prognostic and diagnostic marker. Key messages Smoking appears to have angiogenic effects in early pregnancy with reduced sEng concentrations and elevated PlGF concentrations in both normal and PE pregnancies. Throughout pregnancy, smoking exerted effect in PlGF concentration and sFlt-1/PlGF ratio in PE pregnancies, and thus may complicate its use as a prognostic and diagnostic marker.
吸烟降低子痫前期（PE）风险的生物学机制尚未明确。我们研究了早孕期和晚孕期可溶性 fms 样酪氨酸激酶 1（sFlt-1）、胎盘生长因子（PlGF）及其比值，以及可溶性内皮糖蛋白（sEng）在吸烟女性中的变化。
217 例以后发生 PE 的孕妇和 238 例未发生 PE 的孕妇在早孕期有血清样本，174 例 PE 孕妇和 54 例非 PE 孕妇在中晚孕期有血清样本。
PE 孕妇在妊娠期间吸烟，其早孕期血清 PlGF 浓度升高[几何均数（95%CI）：39.8（32.6-48.5）pg/ml，p=0.001]，sEng 浓度降低[5.0（4.6-5.6）ng/ml，p=0.047]，而 PE 不吸烟者分别为 30.0（28.1-32.1）pg/ml 和 6.1（5.9-6.4）ng/ml。PE 组非吸烟者在早孕期和晚孕期的 sFlt-1/PlGF 比值最高。
吸烟降低 PE 风险的保护作用可能归因于早孕期向促血管生成标志物谱的改变。此外，在晚孕期，吸烟对 PE 妊娠的 sFlt-1/PlGF 比值产生影响，这可能使其作为预后和诊断标志物的应用复杂化。主要结论：吸烟在早孕期似乎有血管生成作用，导致 sEng 浓度降低，正常妊娠和 PE 妊娠中 PlGF 浓度升高。在整个孕期，吸烟对 PE 妊娠的 PlGF 浓度和 sFlt-1/PlGF 比值均有影响，使其作为预后和诊断标志物的应用复杂化。
