Pre-eclampsia
Pre-eclampsia
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DOI：
10.1016/s0140-6736(05)17987-2
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发表时间：
2005-03
期刊：
影响因子：
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通讯作者：
B. Sibai;G. Dekker;M. Kupferminc
中科院分区：
文献类型：
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作者：
B. Sibai;G. Dekker;M. Kupferminc
先兆子痫是孕产妇死亡率（发达国家为15-20%）和发病率（急性和长期）、围产期死亡、早产和宫内生长受限的一个主要原因。主要研究结果支持由免疫适应不良驱动的浅表胎盘的因果或致病模型，随后血管生成生长因子浓度降低，母体循环中胎盘碎片增加，导致（主要是高血压）母体炎症反应。最后一种表型，母体先兆子痫综合征，是由母体已有的心血管或代谢适应度进一步调节的。目前，高危妇女是根据流行病学和临床危险因素确定的，但先兆子痫的诊断标准尚不清楚，没有已知的生物标志物。治疗仍然是产前护理，及时诊断，妥善管理，及时分娩。许多延长妊娠期的干预措施（如治疗轻度高血压、扩大血浆容量和使用皮质类固醇）证据不足。我们对先兆子痫的诊断、危险因素、发病机制及其预测、预防和治疗的现状进行综述。
Pre-eclampsia is a major cause of maternal mortality (15–20% in developed countries) and morbidities (acute and long-term), perinatal deaths, preterm birth, and intrauterine growth restriction. Key findings support a causal or pathogenetic model of superficial placentation driven by immune maladaptation, with subsequently reduced concentrations of angiogenic growth factors and increased placental debris in the maternal circulation resulting in a (mainly hypertensive) maternal inflammatory response. The final phenotype, maternal pre-eclamptic syndrome, is further modulated by pre-existing maternal cardiovascular or metabolic fitness. Currently, women at risk are identified on the basis of epidemiological and clinical risk factors, but the diagnostic criteria of pre-eclampsia remain unclear, with no known biomarkers. Treatment is still prenatal care, timely diagnosis, proper management, and timely delivery. Many interventions to lengthen pregnancy (eg, treatment for mild hypertension, plasma-volume expansion, and corticosteroid use) have a poor evidence base. We review findings on the diagnosis, risk factors, and pathogenesis of pre-eclampsia and the present status of its prediction, prevention, and management.