From the Medical Research Unit in Reproductive Medicine (A.L.-M.), UMAE-Hospital de Ginecología y Obstetricia "Luis Castelazo Ayala", Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, Mexico.
Division of Maternal-Fetal Medicine (C.S.N.-R., L.J.S.-P., K.L.R.-V.), UMAE-Hospital de Ginecología y Obstetricia "Luis Castelazo Ayala", Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, Mexico.
Hypertension. 2019 Oct;74(4):991-997. doi: 10.1161/HYPERTENSIONAHA.119.13348. Epub 2019 Aug 26.
Preeclampsia is characterized by an imbalance in angiogenic factors, including sEng (soluble endoglin). However, the relationship of sEng with the severity of preeclampsia, clinical, and laboratory parameters, and the occurrence of adverse outcomes are not fully elucidated. We studied 1002 women with preeclampsia. Serum concentrations of sEng were measured by ELISA. Serum sEng levels were significantly different (<0.001) in patients with preeclampsia than in healthy pregnancy. In addition, these factors were markedly different in patients with hemolysis, elevated liver enzymes, low platelet count syndrome and eclampsia than in patients with preeclampsia with or without severe features (<0.001) and in patients with preeclampsia with severe features than in those without severe features (<0.001). sEng correlated positively with blood pressure, proteinuria, and levels of creatinine, uric acid, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase; and inversely with gestational age, infant's birth weight, and platelets counts (<0.001 for all). The risk of combined and specific adverse outcomes (pulmonary edema, acute renal failure, placental abruption, hepatic hematoma or rupture, maternal death, cerebral hemorrhage, thrombocytopenia, elevated liver enzymes, preterm delivery, small for gestational age infant, and need for endotracheal intubation, positive inotropic drug support, and hemodialysis) was higher in patients with sEng values in the highest quartile (odds ratio ≥3.1) compared with the lowest quartile. Patients in the highest quartile of sEng were more likely to deliver early compared with those in the lowest quartile (HR, 2.33; 95% CI, 1.91-2.84). We concluded that circulating concentrations of sEng seem to be a suitable marker to assess the severity of preeclampsia and are associated with increased risk of adverse outcomes.
子痫前期的特征是血管生成因子失衡，包括 sEng（可溶性内皮糖蛋白）。然而，sEng 与子痫前期严重程度、临床和实验室参数以及不良结局的发生之间的关系尚未完全阐明。我们研究了 1002 例子痫前期患者。通过 ELISA 测量血清 sEng 浓度。子痫前期患者血清 sEng 水平明显低于健康妊娠者（<0.001）。此外，与子痫前期患者（无严重特征或有严重特征）相比，伴有溶血、肝酶升高、血小板计数降低综合征和子痫的患者的这些因素明显不同（<0.001），与有严重特征的子痫前期患者相比，无严重特征的患者的这些因素也明显不同（<0.001）。sEng 与血压、蛋白尿以及肌酐、尿酸、天门冬氨酸氨基转移酶、丙氨酸氨基转移酶和乳酸脱氢酶水平呈正相关；与胎龄、婴儿出生体重和血小板计数呈负相关（均<0.001）。sEng 值最高四分位数的患者（比值比≥3.1）发生联合和特定不良结局（肺水肿、急性肾衰竭、胎盘早剥、肝血肿或破裂、产妇死亡、脑出血、血小板减少症、肝酶升高、早产、小于胎龄儿和需要气管插管、正性肌力药物支持和血液透析）的风险高于 sEng 值最低四分位数的患者。与 sEng 值最低四分位的患者相比，sEng 值最高四分位的患者更早分娩（HR，2.33；95%CI，1.91-2.84）。我们得出结论，循环 sEng 浓度似乎是评估子痫前期严重程度的合适标志物，并与不良结局风险增加相关。
