Objective To evaluate the expression of hypoxia-inducible factor-la ( HIF-1 a) and its target gene ad-renomedullin(ADM) in placenta during the course of preeclampsia ( PE ) and their relationship in PE and the perinatal outcomes. Methods The expression of HIF-1 a and ADM in placenta of 31 PE women and 27 healthy pregnant women was analyzed with immunohistochemistry and reverse transcription-polymerase chain reaction ( RT-PCR). The clinic data of the maternal complications and the perinatal outcomes were analyzed. Results (l)The expression of both HIF-1 a and ADM were mainly located in the cytoplasm of placental syncytiotrophoblasts, in vascular endothelial cells and a few in the nucleus. Both the expression of HIF-1 a and ADM in placenta of PE were stronger than that of control group(P <0. 05) ; The incidence rate of the maternal complications and the adverse perinatal outcomes of PE were higher than that of control group(P < 0. 05 ). (2)There was positive correlation between the expression of HIF-1 amRNA and ADM mRNA in PE group ( r = 0. 826 ,P < 0. 01) ; There were positive correlations between the expression of ADM mRNA and the mean arterial pressure(MAP) (r=0. 662,P<0.01) ,the maternal complications(r =0. 365 ,P <0. 01)and the adverse perinatal outcomes^ =0. 280, P<0. 05) in PE group;there was negative correlation between the expression of ADM mRNA and the birth weight in PE group ( r = -0. 443 ,P < 0. 01 ). Conclusion Increasing HIF-1 a expression in placenta induces ADM transcription and translation,which leads to mediate maternal systemic vascular dysfunction,organ injury and the maternal complications occurring and plays an important role in preeclampsia and the perinatal outcomes.%目的 探讨子痫前期(preeclampsia,PE)患者胎盘中缺氧诱导因子1α(hypoxia-inducible factor1 α,HIF-1α)及其靶基因肾上腺髓质素( adrenomedullin,ADM)的表达及与子痫前期发病和围产儿预后的关系.方法 应用免疫组化链霉素抗生物素蛋白—过氧化酶连接法(SP法)和逆转录聚合酶链反应(RT-PCR)检测2009年12月至2010年9月福建医科大学附属第一医院31例子痫前期孕妇和27例正常妊娠妇女胎盘中HIF-1α、ADM的表达；同时分析子痫前期、正常妊娠孕妇及国产儿的临床资料.结果 (1) HIF-1α蛋白及ADM蛋白主要表达在胎盘的合体滋养细胞、细胞滋养细胞、血管内皮细胞胞浆及少量胞核中.子痫前期组胎盘中HIF- 1α、ADM蛋白及HIF- 1α、ADM mRNA表达均强于正常组(P＜0.05)；子痫前期组孕妇并发症及围产儿不良结局发生率均高于正常组(P＜0.05)；(2)子痫前期组胎盘HIF-1α、ADM的mRNA表达水平呈正相关(r=0.826,P＜0.01)；ADM mRNA的表达水平与平均动脉压(r=0.662,P＜0.01)、孕妇并发症(r=0.365,P＜0.01)、国产儿不良结局(r=0.280,P＜0.05)均呈正相关；而与新生儿出生体重呈负相关(r=-0.443,P＜0.01).结论 子痫前期中HIF-1α表达升高,促进其靶基因ADM的转录和翻译,介导母体全身血管功能障碍、各脏器损伤及并发症的发生,在子痫前期发病及国产儿预后中起着十分重要的作用.
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