Preeclampsia Pathophysiology, Challenges, and Perspectives
Preeclampsia Pathophysiology, Challenges, and Perspectives
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DOI：
10.1161/circresaha.118.313276
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发表时间：
2019-03-29
影响因子：
20.1
通讯作者：
Karumanchi, S. Ananth
中科院分区：
文献类型：
--
作者：
Rana, Sarosh;Lemoine, Elizabeth;Karumanchi, S. Ananth
妊娠期高血压疾病-慢性高血压，妊娠期高血压和先兆子痫-是独特的挑战，因为病理和其治疗管理同时影响母亲和胎儿，有时把他们的福祉在彼此的矛盾。特别是先兆子痫，是妊娠最可怕的并发症之一。先兆子痫通常在妊娠晚期表现为新发高血压和蛋白尿，可迅速发展为严重并发症，包括母亲和胎儿死亡。虽然先兆子痫的病因仍有争议，但临床和病理学研究表明，胎盘是该综合征发病机制的核心。在这篇综述中，我们将讨论目前的证据异常胎盘的作用和胎盘因素的作用，如抗血管生成因子，sFLT 1（可溶性fms样酪氨酸激酶1）在母体综合征的发病机制先兆子痫。我们将讨论血管生成生物标志物检测疾病风险分层和针对血管生成途径的治疗策略的发展。最后，我们将回顾与妊娠期高血压疾病相关的母亲和儿童的长期心血管和代谢风险，特别是早产儿先兆子痫，以及在无症状阶段增加对干预性研究的关注以延迟女性心血管疾病发作的必要性。
Hypertensive disorders of pregnancy-chronic hypertension, gestational hypertension, and preeclampsia-are uniquely challenging as the pathology and its therapeutic management simultaneously affect mother and fetus, sometimes putting their well-being at odds with each other. Preeclampsia, in particular, is one of the most feared complications of pregnancy. Often presenting as new-onset hypertension and proteinuria during the third trimester, preeclampsia can progress rapidly to serious complications, including death of both mother and fetus. While the cause of preeclampsia is still debated, clinical and pathological studies suggest that the placenta is central to the pathogenesis of this syndrome. In this review, we will discuss the current evidence for the role of abnormal placentation and the role of placental factors such as the antiangiogenic factor, sFLT1 ( soluble fms-like tyrosine kinase 1) in the pathogenesis of the maternal syndrome of preeclampsia. We will discuss angiogenic biomarker assays for disease-risk stratification and for the development of therapeutic strategies targeting the angiogenic pathway. Finally, we will review the substantial long-term cardiovascular and metabolic risks to mothers and children associated with gestational hypertensive disorders, in particular, preterm preeclampsia, and the need for an increased focus on interventional studies during the asymptomatic phase to delay the onset of cardiovascular disease in women.