Increased levels of copeptin before clinical diagnosis of preeclampsia.
Increased levels of copeptin before clinical diagnosis of preeclampsia.
复制标题
DOI：
10.1161/hypertensionaha.114.03762
复制
发表时间：
2014-12
期刊：
影响因子：
--
通讯作者：
Mendola P
中科院分区：
文献类型：
--
作者：
Yeung EH;Liu A;Mills JL;Zhang C;Männistö T;Lu Z;Tsai MY;Mendola P
和肽素是加压素的替代生物标志物，与肾功能下降相关，可作为先兆子痫的有用的早期生物标志物。我们测量了血清和肽素纵向收集的样本在妊娠期间未受影响的对照组（n=136）和病例先兆子痫（n=169），妊娠期糖尿病（n=92），妊娠期高血压（n=101）和早产（n=86）在钙预防先兆子痫试验（1992-1995）。先兆子痫和妊娠期高血压定义为舒张压大于或等于90毫米汞柱的两个场合，分别有和没有蛋白尿。通过logistic回归校正母亲年龄、种族、体重指数、保险状况、婚姻状况、当前吸烟和临床部位，估计与和肽素相关的妊娠并发症风险。与对照组相比，平均妊娠16周时的基线和肽素水平与先兆子痫风险增加相关（校正的比值比和95%置信区间为1.55/log单位; 1.03-2.31）（p=0.03）。37周前确诊的病例（1.86; 1.08-3.20）比37周后确诊的病例（1.45; 0.91-2.32）更强。在病例组和对照组中，和肽素水平均随胎龄增加而升高，但在诊断为先兆子痫的患者中仍显着升高。病例组和对照组之间和肽素水平的差异在接近诊断时变得更加明显。未发现妊娠期高血压无蛋白尿、妊娠期糖尿病或早产无先兆子痫的显著相关性。和肽素水平在诊断为先兆子痫之前在孕妇中升高，升高特异于这种妊娠并发症而不是单独的高血压。我们研究了孕妇血清和肽素（抗利尿激素精氨酸加压素的生物标志物）是否在妊娠合并先兆子痫、妊娠期高血压和妊娠期糖尿病时与无并发症的妊娠相比存在差异，使用的样本来自钙预防先兆子痫试验（1992-1995）。平均妊娠16周时的基线和肽素水平与先兆子痫风险增加呈正相关，即使考虑了母亲年龄、种族、体重指数、保险状况、婚姻状况、当前吸烟和临床部位。在妊娠37周前诊断的病例中，相关性更强，未发现与妊娠期糖尿病或妊娠期高血压相关。我们的研究结果表明，和肽素水平升高的孕妇诊断为先兆子痫与升高特定于这种妊娠并发症，而不是高血压单独。
Copeptin, a surrogate biomarker of vasopressin, has been associated with renal function decline and may serve as a useful early biomarker for preeclampsia. We measured serum copeptin using samples collected longitudinally during pregnancy among unaffected controls (n=136) and cases of preeclampsia (n=169), gestational diabetes (n=92), gestational hypertension (n=101) and preterm birth (n=86) in the Calcium for Preeclampsia Prevention trial (1992–1995). Preeclampsia and gestational hypertension were defined as having a diastolic blood pressure greater than or equal to 90 millimeters of mercury on two occasions with and without proteinuria, respectively. The risk of pregnancy complications associated with copeptin was estimated by logistic regression adjusting for maternal age, race, body-mass index, insurance status, marital status, current smoking, and clinical site. Baseline copeptin levels, at mean 16 weeks of gestation, were associated with increased preeclampsia risk (adjusted odds ratios and 95% confidence interval being 1.55 per log unit; 1.03–2.31) compared to controls (p=0.03). The association was stronger among cases diagnosed before 37 weeks (1.86; 1.08–3.20) than those diagnosed later (1.45; 0.91–2.32). Copeptin levels rose with increasing gestational age in both cases and controls but remained significantly higher among those who were diagnosed with preeclampsia. Differences in levels of copeptin between cases and controls became more apparent closer to time of diagnosis. No significant associations were found for gestational hypertension without proteinuria, gestational diabetes, or preterm birth without preeclampsia. Copeptin levels are elevated in pregnant women prior to diagnosis of preeclampsia with elevation specific to this pregnancy complication rather than hypertension alone. We investigated whether maternal serum copeptin, a biomarker for the antidiuretic hormone arginine vasopressin, differed in pregnancies complicated by preeclampsia, gestational hypertension, and gestational diabetes compared to uncomplicated pregnancies using stored samples from the Calcium for Preeclampsia Prevention trial (1992–1995). Baseline copeptin levels at mean 16 weeks of gestation were positively associated with increased risk of preeclampsia even after accounting for maternal age, race, body-mass index, insurance status, marital status, current smoking, and clinical site. Associations were stronger among cases diagnosed before 37 weeks of gestation and no associations were found for gestational diabetes or gestational hypertension. Our findings demonstrate that copeptin levels are elevated in pregnant women prior to diagnosis of preeclampsia with elevation specific to this pregnancy complication rather than hypertension alone.