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首页> 外文期刊>American Journal of Physiology >Chronic hypertension in pregnancy: impact of ethnicity and superimposed preeclampsia on placental, endothelial, and renal biomarkers
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Chronic hypertension in pregnancy: impact of ethnicity and superimposed preeclampsia on placental, endothelial, and renal biomarkers

机译：妊娠期慢性高血压：种族和叠加的预革胰岛对胎盘，内皮和肾生物标志物的影响

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Black ethnicity is associated with worse pregnancy outcomes in women with chronic hypertension. Preexisting endothelial and renal dysfunction and poor placentation may contribute, but pathophysiological mechanisms underpinning increased risk are poorly understood. This cohort study aimed to investigate the relationship between ethnicity, superimposed preeclampsia, and longitudinal changes in markers of endothelial, renal, and placental dysfunction in women with chronic hypertension. Plasma concentrations of placental growth factor (PlGF), syndecan-1, renin, and aldosterone and urinary angiotensinogen-to-creatinine ratio (AGTCR), protein-to-creatinine ratio (PCR), and albumin-to-creatinine ratio (ACR) were quantified during pregnancy and postpartum in women with chronic hypertension. Comparisons of longitudinal biomarker concentrations were made using log-transformation and random effects logistic regression allowing for gestation. Of 117 women, superimposed preeclampsia was diagnosed in 21% (n = 25), with 24% (n = 6) having an additional diagnosis of diabetes. The cohort included 63 (54%) women who self-identified as being of black ethnicity. PlGF concentrations were 67% lower [95% confidence interval (CI) ?79 to ?48%] and AGTCR, PCR, and ACR were higher over gestation, in women with subsequent superimposed preeclampsia (compared with those without superimposed preeclampsia). PlGF <100 pg/ml at 20–23.9 wk of gestation predicted subsequent birth weight <3rd percentile with 88% sensitivity (95% CI 47–100%) and 83% specificity (95% CI 70–92%). Black women had 43% lower renin (95% CI ?58 to ?23%) and 41% lower aldosterone (95%CI ?45 to ?15%) concentrations over gestation. Changes in placental (PlGF) and renal (AGTCR/PCR/ACR) biomarkers predated adverse pregnancy outcome. Ethnic variation in the renin-angiotensin-aldosterone system exists in women with chronic hypertension in pregnancy and may be important in treatment selection.
机译：黑人种族与慢性高血压患者更糟糕的妊娠结果有关。预先存在的内皮和肾功能紊乱和妊娠不良可能会有所贡献，但致病的病理学机制越来越大的风险被理解。该队列的研究旨在调查种族，叠加的先兆子痫和慢性高血压女性妇女内皮，肾病和胎盘功能障碍标志物的纵向变化之间的关系。胎盘生长因子（PLGF），二癸烷-1，肾素和醛固酮和尿血管生素对肌酐比（AGTCR），蛋白 - 致肌酐比（PCR）和白蛋白至肌酐比（ACR）的血浆浓度在妊娠期和慢性高血压妇女的产后定量。使用允许妊娠的对数转化和随机效应逻辑回归进行纵向生物标志物浓度的比较。在117名女性中，叠加的先兆子痫患者被诊断为21％（n = 25），具有24％（n = 6），具有额外的糖尿病诊断。队列包括63名（54％）妇女，自我确定为黑人种族。 PLGF浓度降低67％[95％置信区间（CI）〜79至48％]和AGTCR，PCR和ACR在妊娠中较高，在随后的叠加的预液柱（与那些没有叠加的PERECLAMPSIA）相比）。 PLGF <100pg / ml在20-23.9周期下妊娠预测后续出生体重<3百分位，灵敏度为88％（95％CI 47-100％）和83％的特异性（95％CI 70-92％）。黑人女性降低了43％的人肾素（95％CI？58至23％），41％降低醛固酮（95％CI→45至10％）浓度在妊娠上。胎盘（PLGF）和肾病（AGTCR / PCR / ACR）生物标志物的变化令人衰竭不良妊娠结果。孕妇患有慢性高血压的女性存在肾素 - 血管紧张素 - 醛固酮系统的种族变异，在治疗选择中可能是重要的。

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