Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Greece.
Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Greece.
Placenta. 2020 Mar;92:9-16. doi: 10.1016/j.placenta.2020.01.014. Epub 2020 Jan 27.
Overproduction of fetal hemoglobin by the placenta leading to increased consumption of endogenous heme scavenging proteins has been recently implicated as a novel pathway in the pathogenesis of preeclampsia. The aim of the present systematic review was to evaluate maternal serum levels of fetal hemoglobin, haptoglobin, heme oxygenase-1, hemopexin and α1-microglobulin, as well as haptoglobin phenotypes among preeclamptic and healthy pregnant women and assess their predictive role in the disease.
Medline, Scopus, CENTRAL, Clinicaltrials.gov and Google Scholar databases were systematically searched from inception. All studies comparing levels of fetal hemoglobin or heme scavengers among preeclamptic and healthy pregnant controls were deemed eligible.
Twenty-three studies were included, with a total number of 7461 pregnant women. Quantitative synthesis was not conducted for the comparison of serum levels due to high heterogeneity. Current evidence suggests that preeclampsia is associated with increased levels of fetal hemoglobin and α1-microglobulin, as well as with lower levels of serum hemopexin. Data regarding serum haptoglobin and heme oxygenase-1 were conflicting, as the available evidence did not unanimously suggest a significant change of their levels in the disease. Network meta-analysis indicated no significant association for any of the haptoglobin phenotypes with preeclampsia development.
The present review suggests that preeclampsia may be associated with increased fetal hemoglobin and α1-microglobulin and decreased hemopexin levels, although inter-study heterogeneity was high. Future large-scale studies are needed to fully elucidate the predictive efficacy of these markers by introducing cut-off values and defining the optimal gestational age for sampling.
胎盘导致胎儿血红蛋白产量增加，从而消耗内源性血红素清除蛋白，这最近被认为是子痫前期发病机制的新途径。本系统评价的目的是评估母体血清中胎儿血红蛋白、触珠蛋白、血红素加氧酶-1、血红素结合蛋白和α1-微球蛋白的水平，以及子痫前期和健康孕妇的触珠蛋白表型，并评估它们在疾病中的预测作用。
系统检索了 Medline、Scopus、CENTRAL、Clinicaltrials.gov 和 Google Scholar 数据库，从成立之初开始。所有比较子痫前期和健康孕妇对照组之间胎儿血红蛋白或血红素清除剂水平的研究均被认为符合条件。
共纳入 23 项研究，总计 7461 名孕妇。由于高度异质性，未进行血清水平比较的定量综合分析。目前的证据表明，子痫前期与胎儿血红蛋白和α1-微球蛋白水平升高以及血清血红素结合蛋白水平降低有关。关于血清触珠蛋白和血红素加氧酶-1的数据存在矛盾，因为现有证据并未一致表明其水平在疾病中发生显著变化。网络荟萃分析表明，任何触珠蛋白表型与子痫前期的发生均无显著相关性。
本综述表明，子痫前期可能与胎儿血红蛋白和α1-微球蛋白水平升高以及血红素结合蛋白水平降低有关，但研究间异质性较高。需要进一步开展大规模研究，通过引入临界值和定义最佳采样孕周，充分阐明这些标志物的预测效果。
