Thagaard Ida Näslund, Hedley Paula L, Holm Jens-Christian, Lange Theis, Larsen Torben, Krebs Lone, Christiansen Michael
Department of Gynecology and Obstetrics, Copenhagen University Hospital Holbæk, Smedelundsgade 60, 4300 Holbæk, Denmark.
Department for Congenital Disorders, Danish National Biobank and Biomarkers, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
Pregnancy Hypertens. 2019 Jan;15:78-83. doi: 10.1016/j.preghy.2018.12.002. Epub 2018 Dec 10.
Preeclampsia (PE) is a serious complication of pregnancy, the pathogenesis of which is largely unknown. We hypothesize that adipocytokines may play a role in the pathogenesis of PE, particularly in obese women, and evaluate leptin and adiponectin as potential first trimester markers for predicting PE.
A cohort of 2503 pregnancies, containing 93 PE pregnancies, was divided into women with normal weight, moderate, or severe obesity. All pregnancies had serum adiponectin and leptin measured in first trimester. Logistic regression was used to model PE with maternal characteristics and concentrations of the biomarkers.
In obese women a lower concentration of adiponectin was found in PE pregnancies; the concentration was lowest in the severely obese (p = 0.005). No association was found in normal weight women (p = 0.72). Leptin concentration had no association with PE in normal weight and moderately obese (p = 0.175-0.072), however in women with severe obesity a lower level of leptin was found (p = 0.049). The AUC was 0.73 for the ROC curve of combined maternal characteristics and adiponectin. Using adiponectin in women with moderate to severe obesity the sensitivity was 72.9% and the specificity was 49%.
In severely obese women, PE is associated with low serum adiponectin and leptin concentrations in first trimester. This indicates that the inability of adipokine regulation to adapt to severe obesity may play a role in the pathogenesis of PE. Adipocytokines may contribute in identification of risk pregnancies among severe obese.
子痫前期（PE）是一种严重的妊娠并发症，其发病机制尚不清楚。我们推测脂肪细胞因子可能在PE的发病机制中起作用，尤其是在肥胖女性中，并评估瘦素和脂联素作为预测PE的潜在孕早期标志物。
对2503例妊娠病例（其中93例为PE妊娠）进行队列研究，将其分为体重正常、中度肥胖或重度肥胖的女性。所有妊娠均在孕早期检测血清脂联素和瘦素。采用逻辑回归分析，以母亲特征和生物标志物浓度为模型来分析PE。
在肥胖女性中，PE妊娠的脂联素浓度较低；在重度肥胖女性中浓度最低（p = 0.005）。在体重正常的女性中未发现相关性（p = 0.72）。瘦素浓度在体重正常和中度肥胖的女性中与PE无相关性（p = 0.175 - 0.072），然而在重度肥胖女性中发现瘦素水平较低（p = 0.049）。母亲特征和脂联素联合的ROC曲线下面积（AUC）为0.73。在中度至重度肥胖女性中使用脂联素，敏感性为72.9%，特异性为49%。
在重度肥胖女性中，PE与孕早期血清脂联素和瘦素浓度低有关。这表明脂肪因子调节无法适应重度肥胖可能在PE的发病机制中起作用。脂肪细胞因子可能有助于识别重度肥胖人群中的高危妊娠。
