Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
Department of Renal Medicine, Division of Transplantation Immunology and Mucosal Biology, King's College London, London, UK.
Eur J Obstet Gynecol Reprod Biol. 2019 Jun;237:151-156. doi: 10.1016/j.ejogrb.2019.04.034. Epub 2019 Apr 19.
Frances Conti-Ramsden MBBS Academic Clinical Fellow, Carolyn Gill PhD BRC Research Assistant, Paul T Seed MSc CStat Senior Lecturer in Medical Statistics, Kate Bramham PhD Clinical Senior Lecturer in Nephrology Lucy C Chappell PhD NIHR Research Professor in Obstetrics, Fergus P McCarthy PhD Clinical Senior Lecturer in Obstetrics and Gynaecology.
To determine whether glycogen phosphorylase isoenzyme B (GPBB) and/or brain natriuretic peptide (BNP) concentrations are elevated in pre-eclampsia and superimposed pre-eclampsia (SPE), demonstrating cardiac ischaemia and strain.
A nested case-control study was performed using samples and clinical data available from a prospective pregnancy cohort. Four groups were selected: healthy pregnant controls (n = 21), pre-eclampsia (n = 19), pre-existing chronic hypertension (CHT) and/or chronic kidney disease (CKD) without (n = 20) or with superimposed pre-eclampsia (SPE) (n = 19). Plasma samples were taken at time of disease or the third trimester in controls.
Plasma concentrations of GPBB and BNP.
There was no significant difference in GPBB plasma concentrations between controls and pre-eclampsia (geometric mean (GM) [95% CI]: 4.74 [2.54-8.84]ng/mL vs 5.01 [2.58-9.74]ng/mL, p = 0.90)), or between CHT and/or CKD and SPE (GM [95% CI]: 9.49 [4.93-18.25]ng/mL vs 10.24 [5.27-19.92]ng/mL, p = 0.87). BNP plasma concentrations were significantly raised in women with pre-eclampsia compared to controls (GM [95% CI]: 31.83 [20.18-50.22]pg/mL vs 11.33 [7.34-17.51]pg/mL, p = 0.001). Women with CKD, but not CHT, who developed SPE had elevated BNP concentrations. There were no significant differences in BNP concentration between women with comorbidity (CHT and/or CKD) and controls.
GPBB has a limited role as a biomarker in hypertensive disorders of pregnancy. BNP concentrations were elevated in pre-eclampsia compared to controls. This suggests cardiac strain at the time of pre-eclampsia. Further studies are needed to examine whether BNP can identify women at increased risk of cardiovascular disease.
Frances Conti-Ramsden，MBBS，医学学术研究员；Carolyn Gill，PhD，BRC 研究助理；Paul T Seed，MSc，CStat，医学统计学高级讲师；Kate Bramham，PhD，肾脏病学临床高级讲师；Lucy C Chappell，PhD，NIHR 妇产科研究教授；Fergus P McCarthy，PhD，妇产科临床高级讲师。
确定糖原磷酸化酶同工酶 B（GPBB）和/或脑利钠肽（BNP）浓度是否在子痫前期和重叠子痫前期（SPE）中升高，表明存在心肌缺血和张力。
使用前瞻性妊娠队列中的样本和临床数据进行嵌套病例对照研究。选择了四个组：健康孕妇对照组（n=21）、子痫前期组（n=19）、无（n=20）或伴有重叠子痫前期（SPE）的慢性高血压（CHT）和/或慢性肾脏病（CKD）（n=19）。对照组在疾病发生时或妊娠晚期采集血浆样本。
GPBB 和 BNP 的血浆浓度。
对照组与子痫前期组之间的 GPBB 血浆浓度无显著差异（几何平均值[95%CI]：4.74[2.54-8.84]ng/mL 与 5.01[2.58-9.74]ng/mL，p=0.90），也无 CHT 和/或 CKD 与 SPE 之间的差异（几何平均值[95%CI]：9.49[4.93-18.25]ng/mL 与 10.24[5.27-19.92]ng/mL，p=0.87）。与对照组相比，子痫前期患者的 BNP 血浆浓度明显升高（几何平均值[95%CI]：31.83[20.18-50.22]pg/mL 与 11.33[7.34-17.51]pg/mL，p=0.001）。患有 SPE 的 CKD 妇女，但不是 CHT，其 BNP 浓度升高。患有合并症（CHT 和/或 CKD）的妇女与对照组相比，BNP 浓度无显著差异。
GPBB 在妊娠高血压疾病中作为生物标志物的作用有限。与对照组相比，子痫前期患者的 BNP 浓度升高。这表明在子痫前期时存在心肌张力。需要进一步研究以检查 BNP 是否可以识别患有心血管疾病风险增加的妇女。
