Itskovitz-Eldor J, Kol S, Lewit N, Sealey J E
Department of Obstetrics and Gynecology, Rambam Medical Center and Technion-Israel Institute of Technology, Faculty of Medicine, Haifa, Israel.
J Clin Endocrinol Metab. 1997 Feb;82(2):461-4. doi: 10.1210/jcem.82.2.3767.
Prorenin is the major product of renin gene expression in the ovary. Plasma levels of prorenin are elevated in ovarian-stimulated patients and during early pregnancy. To further elucidate the source of the elevated plasma levels of prorenin, we measured prorenin, renin activity, angiotensinogen, and steroid hormone levels in the plasma, luteal fluids (luteal cysts), ascitic fluid, and in ovarian venous samples collected from a patient with severe ovarian hyperstimulation syndrome (OHSS) and ectopic pregnancy. Prorenin/renin was also measured in plasma and in peritoneal fluid obtained during, therapeutic paracentesis from four patients with OHSS. Several corpora luteal fluids were obtained that were rich in estradiol (E2) and progesterone (P). Ovarian venous E2 and P were 20-fold higher than in arterial blood and as high or higher than the levels detected in the luteal fluids. The ratios of the hormonal levels in ascitic fluid and plasma were 1.9 for P and 1.4 for E2. A wide range of prorenin concentrations [1279 +/- 918 SD ng/mL/hr, n = 6] were found in corpora luteal fluids, but in each the prorenin concentration was higher than in plasma (494 ng/mL/hr). Prorenin but not renin was higher (+23%) in ovarian venous than arterial blood. Prorenin in the 7 liters of ascitic fluid aspirated (2686 ng/mL/hr) was 5-fold higher than in plasma and similar to the levels measured in the corpora lutea with the highest prorenin concentrations. Renin in luteal cysts and ascitic fluid constituted 3% and 6% of the total renin (renin+prorenin), respectively. Total renin was also higher in peritoneal fluid (1538 +/- 925 ng/mL/hr) than in plasma (375 +/- 237 ng/mL/hr) of the 4 additional patients with severe OHSS. These findings indicate that the ovary secretes prorenin during early pregnancy and that its secretion is directed preferentially from the luteal cysts into the peritoneal cavity. In light of recent evidence of an effect of prorenin on the vascular system, the presence of a huge reservoir of prorenin in the peritoneal cavity of patients with OHSS suggests a potential role for prorenin in the pathogenesis of this syndrome.
肾素原是卵巢中肾素基因表达的主要产物。在接受卵巢刺激的患者和妊娠早期，血浆肾素原水平会升高。为了进一步阐明血浆肾素原水平升高的来源，我们测量了一名患有严重卵巢过度刺激综合征（OHSS）和异位妊娠患者的血浆、黄体液（黄体囊肿）、腹水以及卵巢静脉样本中的肾素原、肾素活性、血管紧张素原和甾体激素水平。还测量了4名OHSS患者在治疗性腹腔穿刺术中获得的血浆和腹腔液中的肾素原/肾素。获得了几份富含雌二醇（E2）和孕酮（P）的黄体液。卵巢静脉中的E2和P比动脉血高20倍，且与黄体液中检测到的水平一样高或更高。腹水中激素水平与血浆中激素水平的比值，P为1.9，E2为1.4。黄体液中发现了广泛的肾素原浓度范围[1279±918 SD ng/mL/小时，n = 6]，但每种黄体液中的肾素原浓度均高于血浆（494 ng/mL/小时）。卵巢静脉中的肾素原而非肾素比动脉血中的高（+23%）。抽取的7升腹水中的肾素原（2686 ng/mL/小时）比血浆中的高5倍，与肾素原浓度最高的黄体中测得的水平相似。黄体囊肿和腹水中的肾素分别占总肾素（肾素+肾素原）的3%和6%。另外4名严重OHSS患者的腹腔液中总肾素（1538±925 ng/mL/小时）也高于血浆（375±237 ng/mL/小时）。这些发现表明，卵巢在妊娠早期分泌肾素原，且其分泌优先从黄体囊肿进入腹腔。鉴于最近有证据表明肾素原对血管系统有影响，OHSS患者腹腔中存在大量肾素原储备提示肾素原在该综合征发病机制中可能发挥作用。
