Delbaere A, Bergmann P J, Gervy-Decoster C, Camus M, de Maertelaer V, Englert Y
Department of Gynecology and Obstetrics, Erasme Hospital, Brussels, Belgium.
Hum Reprod. 1997 Feb;12(2):236-40. doi: 10.1093/humrep/12.2.236.
The pathophysiology of ovarian hyperstimulation syndrome (OHSS) remains unclear. Several lines of evidence indicate that OHSS is associated with a stimulation of the renin-angiotensin system (RAS), but its functional significance as well as its role in the pathogenesis of the syndrome are not yet determined. OHSS is associated with high plasma and ascitic concentrations of total renin, renin activity (RA) and angiotensin II (Ang II). Their ovarian or renal origin is, however, still a matter of debate. To clarify these issues further, total renin, active renin, prorenin, RA and aldosterone were measured in plasma and ascites of nine patients who developed severe OHSS after in-vitro fertilization. Blood and ascites were sampled simultaneously during therapeutic paracentesis. Total renin and prorenin concentrations were significantly higher in the ascites (mean concentration +/- SE respectively of 5920 +/- 1430 mIU/l and 5250 +/- 1350 mIU/l) than in the plasma (respectively 3060 +/- 740 mIU/l and 2000 +/- 460 mIU/l) (P = 0.020 and 0.017 respectively). Conversely, active renin and RA concentrations tended to be lower, although not statistically significantly so in the ascites (respectively 670 +/- 190 mIU/l and 47 +/- 11 ng Ang I/ml/h) than in the plasma (respectively 1060 +/- 370 mIU/l and 75 +/- 21 ng Ang I/ml/h). Aldosterone concentrations were significantly higher in the serum (2609 +/- 374 pg/ml) than in the ascites (2025 +/- 347 pg/ml) (P = 0.015). The concentration gradient between plasma and ascites for total renin and prorenin supports the hypothesis of their ovarian origin in ascites and, to a large extent, in plasma, while it is likely that the high plasma active renin and RA concentrations reflect a peripheral activation of the RAS. In conclusion, the present findings are consistent with a marked stimulation of both ovarian and renal RAS during OHSS.
卵巢过度刺激综合征（OHSS）的病理生理学仍不清楚。有几条证据表明，OHSS与肾素-血管紧张素系统（RAS）的激活有关，但其功能意义以及在该综合征发病机制中的作用尚未确定。OHSS与血浆及腹水中总肾素、肾素活性（RA）和血管紧张素II（Ang II）的高浓度有关。然而，它们的卵巢或肾脏来源仍存在争议。为了进一步阐明这些问题，对9例体外受精后发生严重OHSS的患者的血浆和腹水中的总肾素、活性肾素、肾素原、RA和醛固酮进行了测定。在治疗性腹腔穿刺术期间同时采集血液和腹水样本。腹水中总肾素和肾素原浓度（分别为5920±1430 mIU/l和5250±1350 mIU/l）显著高于血浆（分别为3060±740 mIU/l和2000±460 mIU/l）（P分别为0.020和0.017）。相反，腹水中活性肾素和RA浓度虽有降低趋势，但差异无统计学意义（分别为670±190 mIU/l和47±11 ng Ang I/ml/h），低于血浆（分别为1060±370 mIU/l和75±21 ng Ang I/ml/h）。血清中醛固酮浓度（2609±374 pg/ml）显著高于腹水（2025±347 pg/ml）（P = 0.015）。血浆和腹水之间总肾素和肾素原的浓度梯度支持了它们在腹水以及很大程度上在血浆中来源于卵巢的假说，而血浆中高活性肾素和RA浓度可能反映了RAS的外周激活。总之，目前的研究结果与OHSS期间卵巢和肾脏RAS均受到显著刺激一致。
