Pre-eclampsia part 1: current understanding of its pathophysiology.
Pre-eclampsia part 1: current understanding of its pathophysiology.
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DOI：
10.1038/nrneph.2014.102
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发表时间：
2014-08
期刊：
影响因子：
--
通讯作者：
Romero R
中科院分区：
文献类型：
--
作者：
Chaiworapongsa T;Chaemsaithong P;Yeo L;Romero R
先兆子痫的特征是在妊娠≥20周时新发高血压和蛋白尿。在没有蛋白尿的情况下，诊断需要高血压和全身性疾病的证据（如血小板减少症或肝转氨酶水平升高）。这一多系统疾病以包括肾脏、肝脏和大脑在内的多个器官为目标，是孕产妇和围产期发病率和死亡率的主要原因。肾小球内皮增生症被认为是先兆子痫的特征性病变，但也可发生在健康孕妇中。胎盘在这种疾病的发展中起着至关重要的作用。先兆子痫的发病机制包括有缺陷的深胎盘形成、氧化和内质网应激、1型血管紧张素II受体的自身抗体、血小板和凝血酶活化、血管内炎症、内皮功能障碍和抗血管生成状态的存在，其中血管生成的不平衡已成为最重要的因素之一。然而，这种不平衡并不是先兆子痫所特有的，因为它也发生在宫内生长受限、胎儿死亡、自发性早产和母体底部梗死（大量绒毛周围纤维蛋白沉积）中。血管生成不平衡的严重程度和时间，以及母亲的易感性，可能决定先兆子痫的临床表现。本文就子痫前期的诊断、分类、临床表现及发病机制作一综述。
Pre-eclampsia is characterized by new-onset hypertension and proteinuria at ≥20 weeks of gestation. In the absence of proteinuria, hypertension together with evidence of systemic disease (such as thrombocytopenia or elevated levels of liver transaminases) is required for diagnosis. This multisystemic disorder targets several organs, including the kidneys, liver and brain, and is a leading cause of maternal and perinatal morbidity and mortality. Glomeruloendotheliosis is considered to be a characteristic lesion of pre-eclampsia, but can also occur in healthy pregnant women. The placenta has an essential role in development of this disorder. Pathogenetic mechanisms implicated in pre-eclampsia include defective deep placentation, oxidative and endoplasmic reticulum stress, autoantibodies to type-1 angiotensin II receptor, platelet and thrombin activation, intravascular inflammation, endothelial dysfunction and the presence of an antiangiogenic state, among which an imbalance of angiogenesis has emerged as one of the most important factors. However, this imbalance is not specific to pre-eclampsia, as it also occurs in intrauterine growth restriction, fetal death, spontaneous preterm labour and maternal floor infarction (massive perivillous fibrin deposition). The severity and timing of the angiogenic imbalance, together with maternal susceptibility, might determine the clinical presentation of pre-eclampsia. This Review discusses the diagnosis, classification, clinical manifestations and putative pathogenetic mechanisms of pre-eclampsia.
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