Qureshi Hamna J, Ma Jessica L, Anderson Jennifer L, Bosinski Brett M, Acharya Aditi, Bennett Rachel D, Haas David M, Cox Abigail D, Wodicka George R, Reuter David G, Goergen Craig J
Weldon School of Biomedical Engineering, Purdue University, 206 South Martin Jischke Drive, West Lafayette, IN 47907.
School of Electrical and Computer Engineering, Purdue University, 465 Northwestern Avenue, West Lafayette, IN 47907.
J Eng Sci Med Diagn Ther. 2019 Nov;2(4). doi: 10.1115/1.4045203. Epub 2019 Nov 19.
Preeclampsia leads to increased risk of morbidity and mortality for both mother and fetus. Most previous studies have largely neglected mechanical compression of the left renal vein by the gravid uterus as a potential mechanism. In this study, we first used a murine model to investigate the pathophysiology of left renal vein constriction. The results indicate that prolonged renal vein stenosis after 14 days can cause renal necrosis and an increase in blood pressure (BP) of roughly 30 mmHg. The second part of this study aimed to automate a diagnostic tool, known as the supine pressor test (SPT), to enable pregnant women to assess their preeclampsia development risk. A positive SPT has been previously defined as an increase of at least 20 mmHg in diastolic BP when switching between left lateral recumbent and supine positions. The results from this study established a baseline BP increase between the two body positions in nonpregnant women and demonstrated the feasibility of an autonomous SPT in pregnant women. Our results demonstrate that there is a baseline increase in BP of roughly 10-14 mmHg and that pregnant women can autonomously perform the SPT. Overall, this work in both rodents and humans suggests that (1) stenosis of the left renal vein in mice leads to elevation in BP and acute renal failure, (2) nonpregnant women experience a baseline increase in BP when they shift from left lateral recumbent to supine position, and (3) the SPT can be automated and used autonomously.
子痫前期会增加母亲和胎儿发病和死亡的风险。以往大多数研究在很大程度上忽略了妊娠子宫对左肾静脉的机械压迫这一潜在机制。在本研究中，我们首先使用小鼠模型来研究左肾静脉狭窄的病理生理学。结果表明，14天后肾静脉长期狭窄可导致肾坏死，血压（BP）升高约30 mmHg。本研究的第二部分旨在实现一种称为仰卧位加压试验（SPT）的诊断工具自动化，以便孕妇能够评估自己患子痫前期的风险。先前已将阳性SPT定义为从左侧卧位转为仰卧位时舒张压至少升高20 mmHg。本研究结果确定了非孕妇在两种体位之间的基线血压升高，并证明了孕妇自主进行SPT的可行性。我们的结果表明，血压基线升高约10 - 14 mmHg，且孕妇能够自主进行SPT。总体而言，这项在啮齿动物和人类身上开展的研究表明：（1）小鼠左肾静脉狭窄会导致血压升高和急性肾衰竭；（2）非孕妇从左侧卧位转为仰卧位时血压会出现基线升高；（3）SPT可以实现自动化并由患者自主使用。
