Fetal Medicine Research Institute, King's College Hospital, London, UK.
King's College London, London, UK.
BJOG. 2021 Dec;128(13):2171-2179. doi: 10.1111/1471-0528.16835. Epub 2021 Aug 5.
To assess first trimester serum placental growth factor (PLGF), soluble fms-like tyrosine kinase-1 (sFLT-1), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), endothelin and vascular cell adhesion molecule (VCAM) in women with chronic hypertension (CH) stratified according to blood pressure (BP) control.
Case-control.
Tertiary referral centre.
650 women with CH, 142 normotensive controls.
In the first trimester, patients with CH were subdivided into four groups. Group 1 included women without pre-pregnancy CH presenting with BP ≥140/90 mmHg. Groups 2-4 had pre-pregnancy CH; in group 2 the BP was <140/90 mmHg without antihypertensive medication, in group 3 the BP was <140/90 mmHg with antihypertensive medication, and in group 4 the BP was ≥140/90 mmHg despite antihypertensive medication. PLGF, sFLT-1, IL-6, TNF-α, endothelin and VCAM were measured at 11 -13 weeks' gestation and converted into multiples of the expected median (MoM) using multivariate regression analysis in the controls.
Comparisons of MoM values of PLGF, sFLT-1, endothelin, IL-6, TNF-α and VCAM between the entire cohort of women with CH and the control group were made using Student's t-test or Mann-Whitney U-test. Comparisons between the four CH groups were made using analysis of variance or Kruskal-Wallis tests.
Compared with the control group, women with CH had significantly lower MoM of PLGF, sFLT-1 and IL-6 and a significantly higher MoM of endothelin. Between the four groups of women with CH, there were no significant differences in the MoM of sFLT-1, PLGF, sFLT-1/PLGF ratio, endothelin, IL-6 or VCAM, or in the levels of TNF- α.
In women with CH, differences exist in first trimester angiogenic and inflammatory profiles when compared with normotensive pregnancies. However, these differences do not assist in the stratification of women with CH to identify those with more severe underlying disease and worse pregnancy outcomes.
First trimester blood pressure control impacts on serum PLGF, sFLT-1, endothelin and IL-6 in women with chronic hypertension.
评估根据血压（BP）控制情况分层的慢性高血压（CH）妇女的妊娠早期血清胎盘生长因子（PLGF）、可溶性 fms 样酪氨酸激酶-1（sFLT-1）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、内皮素和血管细胞黏附分子（VCAM）。
病例对照研究。
三级转诊中心。
650 名 CH 妇女，142 名正常血压对照。
在妊娠早期，将 CH 患者分为四组。第 1 组包括无孕前 CH 但血压≥140/90mmHg 的患者。第 2-4 组为孕前 CH 患者；第 2 组血压<140/90mmHg 且未服用降压药，第 3 组血压<140/90mmHg 且服用降压药，第 4 组血压≥140/90mmHg 且服用降压药。在 11-13 周妊娠时测量 PLGF、sFLT-1、IL-6、TNF-α、内皮素和 VCAM，并使用多元回归分析在对照组中将其转换为预期中位数（MoM）的倍数。
使用学生 t 检验或曼-惠特尼 U 检验比较整个 CH 妇女队列与对照组之间 PLGF、sFLT-1、内皮素、IL-6、TNF-α和 VCAM 的 MoM 值。使用方差分析或 Kruskal-Wallis 检验比较 CH 四组之间的 MoM 值。
与对照组相比，CH 妇女的 PLGF、sFLT-1 和 IL-6 的 MoM 显著降低，内皮素的 MoM 显著升高。在 CH 四组妇女中，sFLT-1、PLGF、sFLT-1/PLGF 比值、内皮素、IL-6 或 VCAM 的 MoM 以及 TNF-α的水平均无显著差异。
与正常妊娠相比，CH 妇女在妊娠早期的血管生成和炎症特征存在差异。然而，这些差异并不能帮助 CH 妇女分层，以确定那些潜在疾病更严重、妊娠结局更差的妇女。
妊娠早期的血压控制影响慢性高血压妇女的血清 PLGF、sFLT-1、内皮素和 IL-6。
