Tinsley Harrison Internal Medicine Residency Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.
J Am Coll Cardiol. 2020 Oct 6;76(14):1690-1702. doi: 10.1016/j.jacc.2020.08.014.
Preeclampsia is a hypertensive disorder of pregnancy. It affects 2% to 8% of pregnancies worldwide and causes significant maternal and perinatal morbidity and mortality. Hypertension and proteinuria are the cornerstone of the disease, though systemic organ dysfunction may ensue. The clinical syndrome begins with abnormal placentation with subsequent release of antiangiogenic markers, mediated primarily by soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng). High levels of sFlt-1 and sEng result in endothelial dysfunction, vasoconstriction, and immune dysregulation, which can negatively impact every maternal organ system and the fetus. This review comprehensively examines the pathogenesis of preeclampsia with a specific focus on the mechanisms underlying the clinical features. Delivery is the only definitive treatment. Low-dose aspirin is recommended for prophylaxis in high-risk populations. Other treatment options are limited. Additional research is needed to clarify the pathophysiology, and thus, identify potential therapeutic targets for improved treatment and, ultimately, outcomes of this prevalent disease.
子痫前期是一种妊娠高血压疾病。它影响全球 2%至 8%的妊娠，导致严重的母亲和围产期发病率和死亡率。高血压和蛋白尿是该病的基石，尽管可能会出现全身器官功能障碍。临床综合征始于异常胎盘形成，随后释放抗血管生成标志物，主要由可溶性 fms 样酪氨酸激酶-1（sFlt-1）和可溶性内皮素（sEng）介导。高水平的 sFlt-1 和 sEng 导致内皮功能障碍、血管收缩和免疫失调，这可能对每个母体器官系统和胎儿产生负面影响。本综述全面检查了子痫前期的发病机制，特别关注了临床特征的机制。分娩是唯一的明确治疗方法。建议高危人群使用低剂量阿司匹林进行预防。其他治疗选择有限。需要进一步的研究来阐明病理生理学，从而确定潜在的治疗靶点，以改善这种常见疾病的治疗效果和最终结局。
