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子痫前期易感性中的免疫细胞与感染性疾病

Immune Cells and Infectious Diseases in Preeclampsia Susceptibility.

作者信息

Nieves Cecilia, Victoria da Costa Ghignatti Paola, Aji Narjiss, Bertagnolli Mariane

机构信息

Cardiovascular Health Across the Lifespan Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada; School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada.

Cardiovascular Health Across the Lifespan Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada; School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada.

出版信息

Can J Cardiol. 2024 Dec;40(12):2340-2355. doi: 10.1016/j.cjca.2024.09.012. Epub 2024 Sep 19.

Abstract

Preeclampsia is a severe pregnancy disorder, affecting approximately 10% of pregnancies worldwide, characterised by hypertension and proteinuria after the 20th week of gestation. The condition poses significant risks to both maternal and fetal health, including cardiovascular complications and impaired fetal development. Recent trends indicate a rising incidence of preeclampsia, correlating with factors such as advanced maternal age and cardiovascular comorbidities. Emerging evidence also highlights a notable increase in the association between autoimmune and infectious diseases with preeclampsia. Autoimmune conditions, such as type 1 diabetes and systemic lupus erythematosus, and infections triggered by global health challenges, including leptospirosis, Zika, toxoplasmosis, and Chagas disease, are now recognised as significant contributors to preeclampsia susceptibility by affecting placental formation and function. This review focuses on the immunologic mechanisms underpinning preeclampsia, exploring how immune system dysregulation and infectious triggers exacerbate the condition. It also discusses the pathologic mechanisms, including galectins, that preeclampsia shares with autoimmune and infectious diseases, and their significant risk for adverse pregnancy outcomes. We emphasise the necessity for accurate diagnosis and vigilant monitoring of immune and infectious diseases during pregnancy to optimise management and reduce risks. By raising awareness about these evolving risks and their impact on pregnancy, we aim to enhance diagnostic practices and preventive strategies, ultimately improving outcomes for pregnant women, especially in regions affected by environmental changes and endemic diseases.

摘要

子痫前期是一种严重的妊娠疾病,全球约10%的妊娠会受其影响,其特征为妊娠20周后出现高血压和蛋白尿。该病症对孕产妇和胎儿健康均构成重大风险,包括心血管并发症和胎儿发育受损。近期趋势表明子痫前期的发病率在上升,这与高龄孕产妇和心血管合并症等因素相关。新出现的证据还凸显了自身免疫性疾病和感染性疾病与子痫前期之间的关联显著增加。自身免疫性疾病,如1型糖尿病和系统性红斑狼疮,以及由全球健康挑战引发的感染,包括钩端螺旋体病、寨卡病毒病、弓形虫病和恰加斯病,现在被认为是子痫前期易感性的重要促成因素,因为它们会影响胎盘的形成和功能。本综述聚焦于子痫前期背后的免疫机制,探讨免疫系统失调和感染诱因如何加剧病情。它还讨论了子痫前期与自身免疫性疾病和感染性疾病共有的病理机制,包括半乳糖凝集素,以及它们对不良妊娠结局的重大风险。我们强调在孕期准确诊断和密切监测免疫和感染性疾病以优化管理并降低风险的必要性。通过提高对这些不断演变的风险及其对妊娠影响的认识,我们旨在加强诊断实践和预防策略,最终改善孕妇的结局,尤其是在受环境变化和地方病影响的地区。

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