Di Iorio R, Marinoni E, Letizia C, Alò P, Villaccio B, Cosmi E V
2nd Institute of Obstetrics and Gynecology, the Department of Internal Medicine of Pathology and Experimental Medicine, University "La Sapienza," Rome, Italy.
Hypertension. 1998 Oct;32(4):758-63. doi: 10.1161/01.hyp.32.4.758.
Adrenomedullin is a novel peptide that elicits a long-lasting vasorelaxant activity. Recently, we found high concentrations of adrenomedullin in maternal and umbilical cord plasma and in amniotic fluid in full-term human pregnancy, indicating a role of this peptide during gestation. To investigate the possibility that adrenomedullin is involved in the pathophysiology of preeclampsia, we measured its concentration in maternal and fetoplacental compartments. We studied 12 normotensive nonpregnant women, 13 hypertensive nonpregnant subjects, 29 patients with preeclampsia, and 30 normotensive pregnant women. In all patients, plasma was collected from the cubital vein, and amniotic fluid samples were obtained by transabdominal amniocentesis or at elective cesarean section. Plasma samples from umbilical vein and placental tissues were collected at delivery. Adrenomedullin was assayed on plasma and amniotic fluid samples using a specific radioimmunoassay, and its localization and distribution on placental sections was determined by immunohistochemistry. Adrenomedullin concentrations were higher in hypertensive than in normotensive nonpregnant patients. Pregnant women had higher adrenomedullin levels than nonpregnant subjects, although maternal plasma adrenomedullin concentrations did not differ between normal pregnant and preeclamptic women. Preeclamptic patients showed higher concentrations (P<0.01) than normotensive pregnant women of adrenomedullin in amniotic fluid (252+/-29 versus 112+/-10 fmol/ micromol creatinine) and umbilical vein plasma (18.1+/-2.1 versus 8. 5+/-1.1 fmol/mL). Increased local production of adrenomedullin is associated with preeclampsia. The fetus seems to be responsible for the higher levels of this hormone. Increased adrenomedullin concentrations may be necessary to maintain placental vascular resistance and/or fetal circulation at a physiological level.
肾上腺髓质素是一种能引发持久血管舒张活性的新型肽。最近，我们发现足月妊娠的母体和脐带血浆以及羊水中存在高浓度的肾上腺髓质素，这表明该肽在妊娠期发挥作用。为了研究肾上腺髓质素是否参与先兆子痫的病理生理过程，我们测量了其在母体和胎儿 - 胎盘区域的浓度。我们研究了12名血压正常的未孕女性、13名高血压未孕受试者、29名先兆子痫患者和30名血压正常的孕妇。在所有患者中，从肘静脉采集血浆，通过经腹羊膜穿刺术或选择性剖宫产获取羊水样本。在分娩时采集脐静脉和胎盘组织的血浆样本。使用特异性放射免疫分析法测定血浆和羊水样本中的肾上腺髓质素，并通过免疫组织化学确定其在胎盘切片上的定位和分布。高血压未孕患者的肾上腺髓质素浓度高于血压正常的未孕患者。孕妇的肾上腺髓质素水平高于未孕受试者，尽管正常孕妇和先兆子痫孕妇的母体血浆肾上腺髓质素浓度没有差异。先兆子痫患者羊水中（252±29对112±10 fmol/微摩尔肌酐）和脐静脉血浆中（18.1±2.1对8.5±1.1 fmol/mL）的肾上腺髓质素浓度高于血压正常的孕妇（P<0.01）。肾上腺髓质素局部产生增加与先兆子痫相关。胎儿似乎是这种激素水平升高的原因。肾上腺髓质素浓度升高可能是将胎盘血管阻力和/或胎儿循环维持在生理水平所必需的。
