The Relevance of Pregnancy Induced Hypertension and Free Fatty Acids、thrombomodulin
|School||Hebei Medical University|
|Course||Obstetrics and Gynaecology|
|Keywords||Hypertensive disorders in pregnancy Free fatty acids Thrombomodulin Eclampsia Preeclampsia|
Objective: Hypertensive disorders in pregnancy is a commoncomplication of pregnancy.Most of them occurred after20weeks ofgestation.Its main feature is hypertension and proteinuria.It has a highincidence and has done great harm to pregnant women, fetus and newborn.It isone of the main reasons that lead to increased the mortality rates of maternaland perinatal.So its etiology and pathogenesis are always the research focus inobstetric.In recent years, its etiology has made a new progress.Somebodyproposed endothelial cell activation and injury doctrine,immune imbalancetheory, platelet and neutrophil activation theory etc.Currently, people began toattracted widespread attention on the role that free fatty acids plaied in thehypertensive disorders in pregnancy.Under physiological conditions,the freefatty acid (FFA) is the body’s important energy substance, but it also has ahigh degree of cytotoxicity.It can increase the oxidative stress through lipidperoxidation,stimulate the production of inflammatory cytokines andpromotion of apoptosis.It also can decrease the production of vascularendothelium-derived nitric oxide,and reduce the protective effect of nitricoxide on endothelial cells,then contributing to the damage of the vascularendothelial cells.Thrombomodulin (TM)is a transmembrane glycoprotein thatexists in the surface of endothelial cells.When endothelial cell damage, TMreleases into the blood and plasma TM’s level Increased.Hypertensivedisorders in pregnancy is a disease hypothesized to originate from widespreadendothelial dysfunction or damage.This study intended to explore therelationship between hypertensive disorders in pregnancy and the level ofserum free fatty acids and thrombomodulin and the correlation between freefatty acids and thrombomodulin.Whether the levels of serum free fatty acidsand thrombomodulin can be used as a indicator to assist in the diagnosis of hypertensive disorders in pregnancy or as a surrogate marker to judge theseverity of hypertensive disorders in pregnancy.Methods: Select a total of59pregnant women in the obstetric of theSecond Hospital of Hebei Medical University from October2010to July2011.Removed if somebody has one of the following cases.Such as: receivedmedical treatment in nearly two weeks (such as: the antihypertensive drugs,drugs of cortisol); have severe pregnancy complications(such as: heart, liver,kidney, blood, endocrine and mental diseases etc.);premature rupture ofmembranes;smoking or drinking during pregnancy. The59pregnant womenare divided into two groups. One group for the test group：39cases of pregnantwomen who have diagnosed as hypertensive disorders in pregnancy.Gestational age is34.09±0.19weeks. Average age is26.44±0.57years; Theother was the control group:20cases of normal pregnant women. Gestationalage is37.38±0.38weeks.Average age is27.00±0.47years. There was nosignificant difference about their age between the two groups by t-test（P〉0.05）. However, the gestational age of control group was significantly greaterthan the experimental group（P〈0.05）. To determine the arterial blood pressureof pregnant women’right upper elbow in the state of quiet sitting prenatal.Extraction of about5ml of venous blood on an empty stomach the nextmorning. Placed it into the tubes of procoagulant and upside-down severaltimes, then put it aside.Centrifuge the blood samples and separated serumfrom it（rotation speed:2000r/min, time:10min）.Placed it in the refrigeratorto save at-80℃.Finally determination the level of free fatty acids andthrombomodulin in serum together by enzyme-linked immunoassay method.Results: Compered the group of pregnant women with hypertensivedisorders in pregnancy with normal pregnancy control group:free fatty acids(experimental group:75.65umol/L, control group:67.16umol/L),thrombomodulin (experimental group:2.43ug/L, control group:1.71ug/L),Do two independent samples t-test to both by statistical softwareSPSS13.0,show that: Experimental group were significantly higher than thecontrol group (P <0.01),difference has statistically significant.And do correlation analysis to serum free fatty acids and serum thrombomodulin, theresults show: Both have a significant positive correlation (r=0.892, P <0.01),difference has statistically significant.Conclusion: Compared with normal pregnancy,gestational hypertension’levels of serum free fatty acids and thrombomodulin was significantlyincreased.It suggested that a high level of serum free fatty acid andthrombomodulin may be associated with the incidence of hypertensivedisorders in pregnancy.Serum free fatty acids and serum thrombomodulinhave a significant positive correlation.The pathogenesis may be: Highconcentrations of free fatty acids can enhance the oxidative stress toendothelial cells,and Vascular endothelium-derived nitric oxide productionwas reduced and reduce the protection of endothelial cells to escape fromoxidative stress.It increases lipotoxicity and makes the triglycerideaccumulated within the endothelial cells,then resulting in tissue ischemia andleukocyte activation, finally leads to damage endothelial cells.Thus,itincreased blood pressure, and promoted the development of hypertension.TMis a molecular marker of the response of vascular endothelial cell injury.Itslevel in serum corresponding increase,When the normal endothelial cells ofthe human body disease or injury.It shows that the concentration and thedamage degree of the endothelial cells was positively correlated.Therefore,wecan speculate that there has a certain relationship between the highconcentrations of TM and FFA in serum and the gestational hypertensiondisease’ occurrence and development.And to some extent, it can reflect theseverity of the disease indirectly.