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目的探讨重度早发型子痫前期(ESPE)时母胎肾素血管紧张素系统(RAS)功能状况。方法 ELISA法分别检测34例孕妇空腹静脉血、新生儿脐静脉血清中RAS各组分含量,免疫组化及Western Blot检测ESPE及正常孕妇脐带组织中AT_1R及AT_2R的表达。结果(1)ESPE孕妇血清Ang(1-7)明显高于正常妊娠组,孕妇及新生儿脐血血管紧张素转化酶2(ACE_2)和血管紧张素(1-7)(Ang(1-7))水平显著低于正常对照组,而母儿血清ACE/ACE_2比值均明显增高正常妊娠组;(2)ESPE孕妇脐带组织中AT_1R表达水平明显降低,AT_2R表达与对照组相比无差异。结论(1)血清中ACE/ACE_2相对平衡状态被破坏,使得对机体有保护作用的RAS非经典途径功能削弱孕妇血压上升;(2)AT_1R在脐带静脉中表达降低导致收缩血管、兴奋交感神经等病理生理效应反应降低,可能是ESPE存活子代心血管疾病风险增加的胎儿期因素。
Objective To investigate the functional status of maternal renin angiotensin system (RAS) in severe preeclampsia (ESPE). Methods The levels of RAS in 34 pregnant women with fasting venous blood and neonatal umbilical vein were detected by ELISA. The expressions of AT1R and AT2R in esophageal squamous cell carcinoma were detected by immunohistochemistry and Western Blot. Results The serum levels of Ang (1-7) in ESPE pregnant women were significantly higher than those in normal pregnant women, neonatal pregnant women and newborns, and the levels of angiotensin-converting enzyme 2 (ACE_2) and angiotensin (1-7) )) Was significantly lower than that in the normal control group, while the ratio of serum ACE / ACE2 in both mother and child was significantly higher than that in the normal pregnancy group. (2) The expression of AT1R in umbilical cord tissue of ESPE pregnant women was significantly lower than that in the control group. CONCLUSIONS: (1) The relative balance of ACE / ACE2 in serum is disrupted, making the non-canonical pathway of RAS that has protective effect on the body weaken the increase of blood pressure in pregnant women. (2) The reduction of AT_1R in umbilical vein leads to vasoconstriction, sympathetic excitement and so on Reduced pathophysiological response may be a fetal factor that increases the risk of cardiovascular disease in survivors of ESPE.