早孕期母体肾素-血管紧张素-醛固酮系统激活的决定因素：来自 2 个队列的研究结果。
Determinants of Maternal Renin-Angiotensin-Aldosterone-System Activation in Early Pregnancy: Insights From 2 Cohorts.
机构信息
Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands.
Department of Internal Medicine, Erasmus MC University Medical Center, CA Rotterdam, the Netherlands.
出版信息
J Clin Endocrinol Metab. 2020 Nov 1;105(11):3505-17. doi: 10.1210/clinem/dgaa582.
CONTEXT
The corpus luteum (CL) secretes prorenin, renin's inactive precursor. It may thus contribute to the renin-angiotensin-aldosterone-system (RAAS) activation that is required for maternal adaptation in pregnancy. Whether this activation is disturbed in pregnancies lacking a CL is unknown.
OBJECTIVE
The objective of this work is to investigate maternal RAAS determinants in early pregnancy.
DESIGN AND SETTING
Two observational prospective cohort studies.
TOOK PLACE AT
2 tertiary referral hospitals.
PATIENTS AND INTERVENTION(S): Pregnancies (n = 277) were stratified by CL number and in vitro fertilization (IVF) protocol: 0 CL (programmed cycle frozen embryo transfer [FET], n = 28), 1 CL (natural cycle FET, n = 41 and spontaneous conceptions, n = 139), and more than 1 CL (ovarian stimulation and fresh embryo transfer, n = 69).
METHODS
Quantification was performed for maternal prorenin, renin, and aldosterone blood levels at 5, 9, and 11 weeks of gestation.
RESULTS
Prorenin and renin were lower in the absence of a CL at all time points when compared to 1 CL, whereas prorenin, renin, and aldosterone were higher in the presence of more than 1 CL vs 1 CL (P < .05). Ovarian stimulation with menopausal gonadotropin resulted in higher prorenin, renin, and aldosterone concentrations during the late first trimester than recombinant follicle-stimulating hormone (P < .05). Prorenin, and to a lesser degree renin, correlated positively with serum progesterone and relaxin, but not serum estradiol. Total follicle diameter, body mass index (BMI), polycystic ovary syndrome (PCOS), and antimüllerian hormone (AMH) were additional determinants of circulating prorenin. Finally, pregnancies conceived in the absence of a CL were more disposed to develop preeclampsia.
CONCLUSIONS
CL number, IVF protocol, BMI, PCOS, and AMH affect maternal RAAS activation in early pregnancy, and may thus contribute to pregnancy complications.
背景
黄体（CL）分泌原肾素，即肾素的无活性前体。因此，它可能有助于妊娠中母体适应所需的肾素-血管紧张素-醛固酮系统（RAAS）激活。在缺乏 CL 的妊娠中，这种激活是否受到干扰尚不清楚。
目的
本研究旨在探讨早孕时母体 RAAS 的决定因素。
设计和设置
两项观察性前瞻性队列研究。
地点
2 家三级转诊医院。
患者和干预措施
根据 CL 数量和体外受精（IVF）方案将妊娠分层：0 CL（程序化周期冷冻胚胎移植[FET]，n = 28）、1 CL（自然周期 FET，n = 41 和自然受孕，n = 139）和多于 1 CL（卵巢刺激和新鲜胚胎移植，n = 69）。
方法
在妊娠 5、9 和 11 周时测定母体原肾素、肾素和醛固酮的血水平。
结果
与 1 个 CL 相比，在缺乏 CL 的情况下，所有时间点的原肾素和肾素均较低，而在存在多于 1 个 CL 时，原肾素、肾素和醛固酮均高于 1 个 CL（P <.05）。与重组卵泡刺激素（FSH）相比，促性腺激素引起的卵巢刺激在早孕晚期会导致更高的原肾素、肾素和醛固酮浓度（P <.05）。原肾素和肾素呈正相关与血清孕激素和松弛素相关，但与血清雌二醇无关。总卵泡直径、体重指数（BMI）、多囊卵巢综合征（PCOS）和抗苗勒管激素（AMH）是循环原肾素的其他决定因素。最后，在缺乏 CL 的情况下受孕的妊娠更容易发生子痫前期。
结论
CL 数量、IVF 方案、BMI、PCOS 和 AMH 会影响早孕时母体 RAAS 的激活，从而可能导致妊娠并发症。
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