Altered Retinal Flicker Response Indicates Microvascular Dysfunction in Women With Preeclampsia
Altered Retinal Flicker Response Indicates Microvascular Dysfunction in Women With Preeclampsia
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DOI：
10.1161/hypertensionaha.115.05734
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发表时间：
2015-10-01
期刊：
影响因子：
8.3
通讯作者：
Schlembach, Dietmar
中科院分区：
文献类型：
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作者：
Brueckmann, Andreas;Seeliger, Christin;Schlembach, Dietmar
闪烁引起的扩张在心血管风险患者中减少，并且随着年龄的增长，以下小动脉收缩减少，导致小动脉振幅降低，从而表明微血管内皮功能障碍。由于内皮功能障碍与先兆子痫有关，我们评估了妊娠期和产后的视网膜闪烁反应。在2006年至2013年期间，从德国耶拿大学医院和产前诊断中心埃尔富特招募了妇女，其中34名先兆子痫妇女，45名正常妊娠妇女和22名非妊娠对照妇女被纳入研究。正常妊娠的妇女在年龄、未产、吸烟、既往妊娠期高血压疾病和心血管疾病家族史方面进行匹配。非妊娠女性年龄匹配，未经产，不吸烟，无心血管疾病家族史。使用动态血管分析仪的视网膜血管测量包括50秒基线采集，随后是三个20秒闪烁和80秒弛豫期。先兆子痫妇女在妊娠期间（P=0.001和P=0.008）和产后（P=0.018和P=0.034）小动脉收缩和小动脉振幅降低，校正了年龄、体重指数、平均动脉压、基线直径和心血管疾病家族史。闪烁诱导的扩张在组内和整个研究期间没有变化。不变的闪烁诱导的扩张可能支持保存的微血管的自动调节能力，和小动脉振幅减小，主要是因为没有小动脉收缩，表明开始在妊娠期和产后的先兆子痫的女性视网膜微血管功能障碍。子痫前期患者视网膜闪烁反应改变的机制有待进一步研究。
Flicker-induced dilatation is reduced in patients with cardiovascular risk, and the following arteriolar constriction is reduced with aging, leading to a reduced arteriolar amplitude and, thereby, indicating microvascular endothelial dysfunction. As endothelial dysfunction is associated with preeclampsia, we assessed retinal flicker response during pregnancy and postpartum. Between 2006 and 2013, women were recruited from University Hospital Jena and Prenatal Diagnostic Center Erfurt, Germany, of which 34 women with preeclampsia, 45 women with normal pregnancy, and 22 nonpregnant controls were included in the study. Women with normal pregnancy were matched for age, nulliparity, smoking, previous gestational hypertensive disorders, and family history of cardiovascular disease. Nonpregnant women were age-matched, nulliparous, nonsmoking, without family history of cardiovascular disease. Retinal vessel measurement using Dynamic Vessel Analyzer consisted of 50-seconds baseline acquisition, followed by three 20-second flicker and 80-second relaxation periods. Arteriolar constriction and arteriolar amplitude were reduced during pregnancy (P=0.001 and P=0.008) and postpartum (P=0.018 and P=0.034) in women with preeclampsia, adjusted for age, body mass index, mean arterial pressure, baseline diameter, and family history of cardiovascular disease. Flicker-induced dilatation was unchanged within the groups and throughout the study period. The unchanged flicker-induced dilatation may support a preserved autoregulatory competence of the microvasculature, and the diminished arteriolar amplitude, mainly because of the absence of the arteriolar constriction, indicates a commenced retinal microvascular dysfunction in women with preeclampsia during pregnancy and postpartum. Mechanisms responsible for altered retinal flicker response in preeclampsia need to be clarified in further studies.