Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomised trial
Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomised trial
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DOI：
10.1016/s0140-6736(99)80010-5
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发表时间：
1999-09-04
期刊：
影响因子：
168.9
通讯作者：
Poston, L
中科院分区：
文献类型：
--
作者：
Chappell, LC;Seed, PT;Poston, L
背景氧化应激与先兆子痫的病理生理学有关。这项随机对照试验调查了患有该疾病的风险增加的女性补充维生素 0 和 E 对血管内皮活化和胎盘功能不全的血浆标志物以及先兆子痫发生的影响。方法通过异常两阶段子宫动脉多普勒分析或既往有该疾病病史，283 名女性被确定为先兆子痫的风险增加，并随机分组 在妊娠 16-22 周时分配维生素 C（1000 毫克/天）和维生素 E（400 IU/天）或安慰剂。每月测量内皮激活血浆标志物（纤溶酶原激活剂抑制剂 1 [PAI-1]）和胎盘功能障碍 (PAI-2)，直至分娩。通过蛋白尿高血压的发展来评估先兆子痫。按意向治疗和完成研究的队列进行分析。结果补充维生素 C 和 E 与妊娠期间 PAI-1/PAI-2 比率降低 21% 相关（95% CI 4-35，p=0.015）。在意向治疗队列中，安慰剂组 142 名女性中有 24 名 (17%) 发生先兆子痫，维生素组 141 名女性中有 11 名 (8%) 发生先兆子痫（调整后比值比 0.39 [0.17-0.90]，p=0.02）。在完成研究的队列中（81 名安慰剂组，79 名维生素组），先兆子痫的比值比为 0·24（0.08-0.70，p=0.002）。 解释 补充维生素 C 和 E 可能有益于预防子痫前期风险增加的女性。需要进行多中心试验来证明补充维生素是否会影响低风险女性先兆子痫的发生，并在来自不同人群的更大的高风险女性群体中证实我们的结果。
Background Oxidative stress has been implicated in the pathophysiology of preeclampsia. This randomised controlled trial investigated the effect of supplementation with vitamins 0 and E in women at increased risk of the disorder on plasma markers of vascular endothelial activation and placental insufficiency and the occurrence of pre-eclampsia.Methods 283 women were identified as being at increased risk of preeclampsia by abnormal two-stage uterine-artety doppler analysis or a previous history of the disorder and were randomly assigned vitamin C (1000 mg/day) and vitamin E (400 IU/day) or placebo at 16-22 weeks' gestation. Plasma markers of endothelial activation (plasminogen-activator inhibitor 1 [PAI-1]) and placental dysfunction (PAI-2) were measured every month until delivery. Preeclampsia was assessed by the development of proteinuric hypertension. Analyses were done by intention to treat, and in the cohort who completed the study.Findings Supplementation with vitamins C and E was associated with a 21% decrease in the PAI-1/PAI-2 ratio during gestation (95% CI 4-35, p=0.015). In the intention-to-treat cohort, preeclampsia occurred in 24 (17%) of 142 women in the placebo group and 11 (8%) of 141 in the vitamin group (adjusted odds ratio 0.39 [0.17-0.90], p=0.02). In the cohort who completed the study (81 placebo group, 79 vitamin group), the odds ratio for preeclampsia was 0 24 (0.08-0.70, p=0.002).Interpretation Supplementation with vitamins C and E may be beneficial in the prevention of preeclampsia in women at increased risk of the disease. Multicentre trials are needed to show whether vitamin supplementation affects the occurrence of preeclampsia in low-risk women and to confirm our results in larger groups of high-risk women from different populations.