Department of Obstetrics and Gynecology, Division of Perinatology, Trakya University Faculty of Medicine, Edirne, Turkey.
J Obstet Gynaecol. 2022 Jul;42(5):923-928. doi: 10.1080/01443615.2021.1960293. Epub 2021 Oct 25.
Our objective is to investigate maternal midtrimester plasma and amniotic fluid (AF) levels of angiopoietin-2 (Ang-2) and thrombomodulin (TM), which are involved in vascular remodelling and endothelium activation, in placental disorders including foetal growth restriction (FGR) and preeclampsia (PE). This prospective multiparametric pilot study was conducted at the Perinatology Division of Trakya University in a population undergoing genetic amniocentesis. Both AF and plasma aliquots were kept in -80 °C until ELISA assay. The pregnancies were followed up until the end of gestation in terms of obstetric results. Amniotic fluid and plasma aliquots from 127 pregnancies who underwent genetic amniocentesis between 16 and 24 weeks of gestation were analysed. During the final data evaluation, 39 were excluded with various reasons. Twelve subsequently developed FGR and 11 complicated with PE. The control group ( = 65) was consisted of women delivered >37th week with an uncomplicated outcome. The midtrimester maternal Ang-2 levels in both AF and plasma and also TM levels in plasma were found to be significantly increased in pregnancies who subsequently developed FGR or PE (< .05). The midtrimester Ang-2, which rises in both plasma and AF and the midtrimester TM, which only significantly increase in plasma compartment in PE group, as compensatory mechanism may be the precursors of placental disorders including FGR and PE.Impact Statement It is known that angiopoietin-2 (Ang-2) has important role in placental angiogenesis and vascular remodelling. TM which is a receptor for Ang-2 plays a protective role in pregnancy by preventing the uteroplacental circulation from thrombosis. The present study demonstrates that both midtrimester maternal plasma Ang-2/TM and amniotic fluid (AF) Ang-2 levels were significantly higher in PE and FGR group than uncomplicated group. Midtrimester AF TM levels were not significantly higher in PE group than the control group. In the clinical practice, high levels of midtrimester Ang-2 and TM in plasma may be used for the prediction of FGR and PE. Although amniocentesis is not practical in the clinical use, the levels of these two markers in both AF and plasma compartments may contribute to explain the pathophysiology of FGR and PE.
我们的目的是研究在包括胎儿生长受限（FGR）和子痫前期（PE）在内的胎盘疾病中，参与血管重塑和内皮细胞激活的血管生成素-2（Ang-2）和血栓调节蛋白（TM）在母体中期血浆和羊水（AF）中的水平。这项前瞻性多参数初步研究是在特拉基亚大学围产期部门在接受遗传羊膜穿刺术的人群中进行的。将 AF 和血浆等分试样保持在-80°C，直到 ELISA 测定。根据产科结果，监测妊娠直至妊娠末期。分析了 127 例在妊娠 16 至 24 周期间接受遗传羊膜穿刺术的妊娠的羊水和血浆等分试样。在最终数据评估中，由于各种原因排除了 39 例。随后有 12 例发展为 FGR，11 例并发 PE。对照组（n=65）由在无并发症的情况下分娩超过 37 周的妇女组成。随后发展为 FGR 或 PE 的妊娠中，AF 和血浆中的母体中期 Ang-2 水平以及血浆中的 TM 水平均显着升高（<0.05）。中期 Ang-2 在血浆和 AF 中升高，中期 TM 在 PE 组中仅在血浆隔室中显着升高，作为代偿机制，可能是包括 FGR 和 PE 在内的胎盘疾病的前兆。
影响陈述
已知血管生成素-2（Ang-2）在胎盘血管生成和血管重塑中起重要作用。TM 是 Ang-2 的受体，通过防止子宫胎盘循环血栓形成，在妊娠中起保护作用。本研究表明，PE 和 FGR 组的母体中期血浆 Ang-2/TM 和羊水（AF）Ang-2 水平均显着高于对照组。PE 组的中期 AF TM 水平与对照组相比没有显着升高。在临床实践中，中期血浆 Ang-2 和 TM 水平升高可能用于预测 FGR 和 PE。尽管羊膜穿刺术在临床应用中并不实用，但这两种标志物在 AF 和血浆隔室中的水平可能有助于解释 FGR 和 PE 的病理生理学。
