: Нормальная беременность вовлекает, отметил материнскую hemodynamic адаптацию; они подавлены в преэклампсии, ведя к серьезным осложнениям для матери и ребенка. Причина преэклампсии неизвестна, но может вовлекать первичную патологию в материнской/эмбриональной внутренней поверхности. Однако, системные проявления болезни связаны с широко распространенным материнским сосудистым эндотелиальным повреждением и дисфункцией. Был значительный недавний интерес в возможных ролях для оксида азота (NO) дефицит и для альтераций renin angiotensin система (RAS) в патофизиологии преэклампсии. Во время - краткий обзор hemodynamic реакций на нормальную беременность, оценка возможных ролей NO и RAS в этой адаптации, и обзоре важных аспектов этих систем в преэклампсии.
TI: Plasma concentrations of asymmetric dimethylarginine, a natural inhibitor of nitric oxide synthase, in normal pregnancy and preeclampsia. :
Плазменные концентрации асимметричного dimethylarginine, естественный ингибитор оксида азота synthase, в нормальной беременности и преэклампсии.
AU: Holden-DP; Fickling-SA; Whitley-GS; Nussey-SS
AD: Department of Cellular and Molecular Sciences, St George's Hospital Medical School, London, United Kingdom.
SO: Am-J-Obstet-Gynecol. 1998 Mar; 178(3): 551-6
CP: UNITED-STATES
AB: OBJECTIVE: We investigated the change in the plasma concentration of asymmetric dimethylarginine, an endogenous inhibitor of nitric oxide synthase, in early-, mid-, and late-gestation normotensive pregnancies and in gestational age-matched preeclamptic pregnancies and compared the observed changes with changes in blood pressure. STUDY DESIGN: Blood pressure and peripheral plasma asymmetric dimethylarginine concentrations were measured in 20 nonpregnant and 145 pregnant women (33 first-trimester, 50 second-trimester, and 44 third-trimester normotensive pregnancies and 18 third-trimester pregnancies complicated by preeclampsia). In 23 normotensive pregnancies serial plasma asymmetric dimethylarginine concentrations were measured. Statistical analysis was by analysis of variance and linear regression. RESULTS: The blood pressures recorded throughout normal pregnancy were significantly lower than in nonpregnant subjects (p < 0.0001). The mean systolic, diastolic, and average blood pressures were significantly higher in the second-trimester groups than in the first-trimester groups, whereas in the third trimester average and diastolic blood pressures were significantly higher than in the second trimester. The mean (+/-SD) systolic and diastolic blood pressures in third-trimester preeclamptic patients was 157.7 +/- 11.2 and 110.9 +/- 8.5 mm Hg. The mean plasma asymmetric dimethylarginine concentration in nonpregnant women was 0.82 +/- 0.31 micromol/L (significantly higher than in normotensive pregnancy, p < 0.0001). The plasma asymmetric dimethylarginine concentration was also significantly higher in second-trimester than in first-trimester normotensive groups (respectively, 0.52 +/- 0.20 micromol/L and 0.40 +/- 0.15 micromol/L, p = 0.001) and was higher in third-trimester normotensive pregnancy 0.56 +/- 0.23 micromol/L than it was in the second trimester. The asymmetric dimethylarginine concentration in third-trimester preeclamptic patients was 1.17 +/- 0.42 micromol/L (p < 0.0001 vs normotensive third-trimester subjects). CONCLUSIONS: It is well recognized that blood pressure falls in early normal pregnancy and rises again toward term. These studies show that the early fall in blood pressure is accompanied by a significant fall in the plasma asymmetric dimethylarginine concentration. Later in pregnancy circulating concentrations increase and, when pregnancy is complicated by preeclampsia, concentrations are higher than in the nonpregnant state. Our data support a role for both asymmetric dimethylarginine and nitric oxide in the changes in blood pressure seen in both normal and preeclamptic pregnancy.
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