Leaños-Miranda Alfredo, Méndez-Aguilar Francisco, Molina-Pérez Carlos José, Ramírez-Valenzuela Karla Leticia, Sillas-Pardo Liliana Janet, Uraga-Camacho Navid Claudian, Isordia-Salas Irma, Berumen-Lechuga María Guadalupe
Medical Research Unit in Reproductive Medicine.
Division of Maternal-Fetal Medicine, UMAE-Hospital de Ginecología y Obstetricia "Luis Castelazo Ayala," Instituto Mexicano del Seguro Social (IMSS), Ciudad de México.
Medicine (Baltimore). 2018 Sep;97(39):e12498. doi: 10.1097/MD.0000000000012498.
Preeclampsia is characterized by an increased sensitivity to angiotensin II (Ang II). We herein assessed whether serum Ang II levels measured by a new developed bioassay are associated with preeclampsia, its severity, and the risk for developing this disease.Using a cross-sectional design, we studied 90 pregnant women (30 healthy pregnant and 60 with preeclampsia [30 with- and 30 without severe features]). We also used a nested case-control study with 30 women who eventually developed preeclampsia and 31 normotensive controls. Serum samples were collected at diagnosis of preeclampsia or at 4-week intervals (from weeks 12th to 36th). Ang II was measured using a bioassay.At diagnosis of preeclampsia, serum Ang II concentrations were significantly lower in preeclampsia without and with severe features (P = .001 and P < .001, respectively) than in healthy pregnancy. In addition, Ang II was different in preeclampsia with severe features than in those without severe features (P = .048). Women who subsequently developed preeclampsia had lower Ang II levels than women with normal pregnancies, and these changes became significant at 24 weeks onward. The risk to developing preeclampsia was higher among women with Ang II concentration values in the lowest quartile of the control distribution from 12 weeks onward (odds ratio ranging from 3.8 [95% CI 1.3-11.1] to 6.5 [95% CI 1.6-26.9]).We concluded that concentrations of Ang II are markedly diminished at diagnosis of preeclampsia and are closely associated with the severity of disease. Changes in circulating levels of Ang II precede the clinical presentation of preeclampsia.
子痫前期的特征是对血管紧张素II（Ang II）的敏感性增加。我们在此评估通过新开发的生物测定法测量的血清Ang II水平是否与子痫前期、其严重程度以及患此病的风险相关。
采用横断面设计，我们研究了90名孕妇（30名健康孕妇和60名子痫前期患者[30名有严重特征和30名无严重特征]）。我们还进行了一项巢式病例对照研究，其中30名最终患子痫前期的女性和31名血压正常的对照者。在子痫前期诊断时或每隔4周（从第12周到第36周）采集血清样本。使用生物测定法测量Ang II。
在子痫前期诊断时，无严重特征和有严重特征的子痫前期患者血清Ang II浓度均显著低于健康妊娠者（分别为P = 0.001和P < 0.001）。此外，有严重特征的子痫前期患者与无严重特征的患者相比，Ang II水平不同（P = 0.048）。随后患子痫前期的女性Ang II水平低于正常妊娠女性，这些变化在24周后变得显著。从12周起，Ang II浓度值处于对照分布最低四分位数的女性患子痫前期的风险更高（比值比范围从3.8[95%可信区间1.3 - 11.1]到6.5[95%可信区间1.6 - 26.9]）。
我们得出结论，子痫前期诊断时Ang II浓度显著降低，且与疾病严重程度密切相关。Ang II循环水平的变化先于子痫前期的临床表现。
