From the Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA (H.E.S.); Department of Obstetrics and Gynecology (R.H.L.) and Division of Rheumatology, Department of Medicine (W.S.), Los Angeles County+University of Southern California Medical Center, Keck School of Medicine of the University of Southern California; Department of Biotechnology Discovery Research, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN (J.M., K.K.); and Childbirth Research Associates, North Hollywood, CA (L.M.K.).
Hypertension. 2017 Nov;70(5):1007-1013. doi: 10.1161/HYPERTENSIONAHA.117.09775. Epub 2017 Sep 18.
Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality. Early suppression of B-cell lymphopoiesis is necessary for a normal pregnancy. Dysregulation of factors critical to B-cell survival may result in pregnancy complications, including hypertension. In this prospective observational study at a single medical center, serum levels of BAFF (B-cell activating factor) were measured in pregnant participants at each trimester, at delivery, and postpartum and in nonpregnant controls at a single time point. Comparisons were made between nonpregnant and pregnant subjects and between time periods of pregnancy. First-trimester serum BAFF levels were further tested for association with hypertensive disorders of pregnancy. The study included 149 healthy pregnant women, 25 pregnant women with chronic hypertension, and 48 nonpregnant controls. Median first-trimester serum BAFF level (ng/mL) for healthy women (0.90) was lower than median serum BAFF levels for women with chronic hypertension (0.96; =0.013) and controls (1.00; =0.002). Serum BAFF levels steadily declined throughout pregnancy, with the median second-trimester level lower than the corresponding first-trimester level (0.77; =0.003) and the median third-trimester level lower than the corresponding second-trimester level (0.72; =0.025). The median first-trimester serum BAFF level was elevated in women who subsequently developed hypertension compared with women who remained normotensive (1.02 versus 0.85; =0.012), with the area under the receiver operating characteristic curve being 0.709. First-trimester serum BAFF level may be an early and clinically useful predictor of hypertensive disorders of pregnancy.
妊娠高血压疾病是孕产妇和围产儿发病率和死亡率的主要原因。正常妊娠需要早期抑制 B 细胞淋巴生成。B 细胞存活关键因子的失调可能导致妊娠并发症，包括高血压。在单中心前瞻性观察研究中，在每个孕早期、分娩时和产后以及非孕对照组的单个时间点测量了妊娠参与者的血清 BAFF（B 细胞激活因子）水平。比较了非孕和妊娠受试者以及妊娠各时期之间的差异。进一步检测了孕早期血清 BAFF 水平与妊娠高血压疾病的相关性。该研究纳入了 149 名健康孕妇、25 名慢性高血压孕妇和 48 名非孕对照者。健康孕妇的孕早期血清 BAFF 中位数（ng/mL）为 0.90，低于慢性高血压孕妇（0.96；=0.013）和对照组（1.00；=0.002）的中位数。随着妊娠的进展，血清 BAFF 水平逐渐下降，中位孕中期水平低于相应的孕早期水平（0.77；=0.003），中位孕晚期水平低于相应的孕中期水平（0.72；=0.025）。与血压正常的孕妇相比，随后发生高血压的孕妇的孕早期血清 BAFF 中位数水平升高（1.02 与 0.85；=0.012），接受者操作特征曲线下面积为 0.709。孕早期血清 BAFF 水平可能是预测妊娠高血压疾病的早期和临床有用的指标。
