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子痫前期:全面综述。

Preeclampsia: A comprehensive review.

机构信息

Department of Gynecology and Obstetrics, Shaikh Zaid Women Hospital Larkana, Shaheed Mohtarma Benazir Bhutto Medical University (SMBB) Larkana, Pakistan.

Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Jaffer Khan Jamali Road, H-8/4, Islamabad, Pakistan.

出版信息

Clin Chim Acta. 2024 Sep 15;563:119922. doi: 10.1016/j.cca.2024.119922. Epub 2024 Aug 13.

Abstract

Preeclampsia (PE) is a life-threatening disease of pregnancy and a prominent cause of neonatal and maternal mortality and morbidity. PE affects approximately 5-10% of pregnancies worldwide, posing significant risks to perinatal and maternal health. It is characterized by a variety of interconnected pathological cascades contributing to the stimulation of intravascular inflammation, oxidative stress (OS), endothelial cell activation, and syncytiotrophoblast stress that converge on a common pathway, ultimately resulting in disease progression. The present study was designed and executed to review the existing scientific literature, specifically focusing on the etiology (gestational diabetes mellitus and maternal obesity, insulin resistance, metabolic syndrome, maternal infection, periodontal disease, altered microbiome, and genetics), clinical presentations (hypertension, blood disorders, proteinuria, hepatic dysfunction, renal dysfunction, pulmonary edema, cardiac dysfunction, fetal growth restrictions, and eclampsia), therapeutic clinical biomarkers (creatinine, albuminuria, and cystatin C) along with their associations and mechanisms in PE. In addition, this study provides insights into the potential of nanomedicines for targeting these mechanisms for PE management and treatment. Inflammation, OS, proteinuria, and an altered microbiome are prominent biomarkers associated with progression and PE-related pathogenesis. Understanding the molecular mechanisms, exploring suitable markers, targeted interventions, comprehensive screening, and holistic strategies are critical to decreasing the incidence of PE and promoting maternal-fetal well-being. The present study comprehensively reviewed the etiology, clinical presentations, therapeutic biomarkers, and preventive potential of nanomedicines in the treatment and management of PE.

摘要

子痫前期 (PE) 是一种危及生命的妊娠疾病,也是新生儿和孕产妇死亡和发病的主要原因。PE 影响全球约 5-10%的妊娠,对围产期和孕产妇健康构成重大威胁。它的特征是多种相互关联的病理级联反应,导致血管内炎症、氧化应激 (OS)、内皮细胞激活和合体滋养层应激的刺激,这些反应汇聚在一个共同的途径上,最终导致疾病进展。本研究旨在回顾现有的科学文献,特别关注病因(妊娠糖尿病和母体肥胖、胰岛素抵抗、代谢综合征、母体感染、牙周病、微生物组改变和遗传)、临床表现(高血压、血液疾病、蛋白尿、肝功能障碍、肾功能障碍、肺水肿、心功能障碍、胎儿生长受限和子痫)、治疗临床生物标志物(肌酐、蛋白尿和胱抑素 C)及其在 PE 中的关联和机制。此外,本研究还探讨了纳米医学在针对这些机制进行 PE 管理和治疗方面的应用潜力。炎症、OS、蛋白尿和微生物组改变是与进展和 PE 相关发病机制相关的突出生物标志物。了解分子机制、探索合适的标志物、靶向干预、全面筛查和整体策略对于降低 PE 的发生率和促进母婴健康至关重要。本研究全面综述了纳米医学在治疗和管理 PE 中的病因、临床表现、治疗生物标志物和预防潜力。

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