妊娠高血压疾病患者产后远期代谢、心血管、脑血管及肾脏疾病的患病率
Prevalence of long term metabolic, cardiovascular, cerebrovascular and renal disease in patients with hypertensive disorders in pregnancy remote from pregnancy (POMCH).
作者信息
Schroers Jade Elizabeth, Shanmugalingam Renuka, Lee Gaksoo, Rutherford David, Makris Angela
机构信息
Southwest Sydney Local Health District, NSW, Australia.
Southwest Sydney Local Health District, NSW, Australia; Women's Health Initiative Translational Unit, Ingham Institute, Campbell St, Liverpool, NSW, Australia; School of Medicine Western Sydney University, Locked Bag 1797, Penrith, NSW, Australia; Clinical School, South Western Sydney, University New South Wales, Liverpool Hospital, Liverpool, Australia.
出版信息
Pregnancy Hypertens. 2022 Jun;28:162-167. doi: 10.1016/j.preghy.2022.04.004. Epub 2022 Apr 27.
BACKGROUND
Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of long-term cardiovascular, cerebrovascular, and adverse renal outcomes. Biomarkers including soluble fms-like tyrosine kinase 1 (sFlt1), placental growth factor (PlGF) are predictive of the development of preeclampsia. Their long-term value in predicting which women will develop cardiovascular complications remote from pregnancy is not yet established.
OBJECTIVES
To determine the prevalence and incidence of Cardio-renal-metabolic outcomes at 10 years follow-up in a cohort of women screened for suspected preeclampsia from 2008 to 2009 and assess the relationship between pregnancy biomarkers and long-term outcomes.
STUDY DESIGN
A retrospective cohort study of 117 women. Outcomes were assessed by auditing medical records. The primary outcome was the prevalence of cardiovascular, cerebrovascular, metabolic and renal outcomes at 10 years remote from the diagnosis of HDP. The secondary outcome was to assess the relationship of the remote from pregnancy outcomes to biomarkers (sFlt1, PlGF, soluble endoglin (sEng) and neutrophil gelatinase associated lipocalin (NGAL)) taken at the time of pregnancy comparing the results of those with adverse outcomes compared to those without.
RESULTS
There was a 12.7% prevalence of cardiovascular and cerebrovascular disease, 44.4% prevalence of hypertension, 20.6% prevalence of chronic kidney disease and 17.5% prevalence of diabetes. Women who developed preeclampsia had an increased prevalence and incidence of adverse outcomes compared to women without preeclampsia. There was a weak relationship between sENg measured at the time of clinical suspicion of preeclampsia and the adverse outcomes 144 (139-146) months remote from pregnancy.
CONCLUSIONS
Biomarkers taken at the time of pregnancy did not accurately predict the long-term adverse cardiometabolic outcomes.
背景
妊娠高血压疾病（HDP）与长期心血管、脑血管及不良肾脏结局风险增加相关。包括可溶性fms样酪氨酸激酶1（sFlt1）、胎盘生长因子（PlGF）在内的生物标志物可预测先兆子痫的发生。它们在预测哪些女性会在妊娠后期发生心血管并发症方面的长期价值尚未确立。
目的
确定2008年至2009年筛查疑似先兆子痫的女性队列在10年随访中心肾代谢结局的患病率和发病率，并评估妊娠生物标志物与长期结局之间的关系。
研究设计
一项对117名女性的回顾性队列研究。通过审核病历评估结局。主要结局是在距HDP诊断10年时心血管、脑血管、代谢和肾脏结局的患病率。次要结局是评估妊娠后期结局与妊娠时所测生物标志物（sFlt1、PlGF、可溶性内皮糖蛋白（sEng）和中性粒细胞明胶酶相关脂质运载蛋白（NGAL））之间的关系，比较有不良结局者与无不良结局者的结果。
结果
心血管和脑血管疾病的患病率为12.7%，高血压患病率为44.4%，慢性肾病患病率为20.6%，糖尿病患病率为17.5%。与未发生先兆子痫的女性相比，发生先兆子痫的女性不良结局的患病率和发病率更高。临床怀疑先兆子痫时所测sEng与距妊娠144（139 - 146）个月时的不良结局之间存在微弱关系。
结论
妊娠时所测生物标志物不能准确预测长期不良心脏代谢结局。
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