Study On The Relationship Between Perinatal Outcomes In Patients With Preeclampsia And SFlt-1

The pathogenesis of preeclampsia is complex; numerous genetic, immunologic, and environmental factors interact. It has been suggested that preeclampsia is a two-stage disease, he first stage is asymptomatic, characterized by abnormal placental development during the first trimester resulting in placental insufficiency and the release of excessive amounts of placental materials into the maternal circulation. This in turn leads to the second, symptomatic stage, wherein the pregnant woman develops characteristic hypertension, renal impairment, and proteinuria and is at risk for the HELLP syndrome (hemolysis, elevated liver function enzymes and low platelets), eclampsia, and other end-organ damage. Its core is the pathological changes of vascular endothelial cell dysfunction.Discussion on the three aspects of this research from causing mechanism of Vascular Endothelial dysfunction in patients with preeclampsia and its relationship with clinical outcomes. 1、Placental vascular factor expression of VEGF, PIGF, sFlt-1, Flt-1 and the relationship between preeclampsia2、Abnormal maternal peripheral blood levels of sFlt-1 and the relationship between preeclampsia and correlation with perinatal outcomes.3、The relationship between postpartum recovery and sFlt-1 level in maternal peripheral blood during pregnancy.Part 1:Placental expression of VEGF, PIGF, Flt-1, sFlt-1mRNA and correlation of preeclampsiaObjective:Placental vascular endothelial growth factor (VEGF) placenta growth factor (PIGF) and vascular endothelial growth factor receptor 1 (VEGFR1, Flt-1), soluble vascular endothelial growth factor receptor 1 (sVEGFR1,sFlt-1) of the mRNA expression and relationship between preeclampsia. Method:90 pregnant women giving birth in the obstetric department of Tianjin first Central Hospital.45 cases of maternal health is the control group, the average age (26.3±2.2) gestation weeks (37.41±2.47). For the Group of 45 cases of patients with preeclampsia; average age (27.7±2.6) weeks (35.44±0.86) severe 25 cases, mild 20 cases. Reverse transcription-polymerase chain reaction (RT-PCR) methods for detection of placental tissue in the expression of VEGF and PLGF, Flt-1, sFlt-lmRNA.Result:Preeclampsia placenta tissue VEGF and PIGF Flt-1, sFlt-1mRNA expression are higher than the control group(4.05±0.39,2.970±0.35,3.48±0.73,0.60±0.09 vs 1.38±0.36±0.37,1.51±0.76,,0.14±0.26).The difference are significant (P<0.01). Conclusion:sFlt-lmRNA high expression of placental tissue and endothelial damage in preeclampsia women closely, hypertension and proteinuria occurs.Part 2:SFlt-1 concentration in peripheral blood of pregnant women with preeclampsia relationship between perinatal outcomes.Objective:1.By comparing the sFlt.-1 concentrations in maternal peripheral blood in patients with preeclampsia and normal differences between pregnant women, understand the impact of sFlt-1 on the pathogenesis of preeclampsia.2. Analysis of peripheral blood concentration of sFlt and correlation of adverse pregnancy outcomes. Method:60 cases of severe preeclampsia patients,30 cases of mild preeclampsia,30 healthy pregnant women. Compared three groups of pregnant women in General and sFlt-1 in peripheral blood concentration differences, gestational and neonatal weight. Result:SFlt-1 there are significant differences between the three group (P＜0.01). Severe neonatal weight less than mild and control groups, mild group and control group no significant difference (P>0.05)。Conclusion:Peripheral blood of preeclampsia sFlt-1 level is significantly higher than in normal pregnant women, sFlt-1 levels and the extent of the disease concerned.Part 3:Early onset and late onset severe pre-eclampsia’s basic, clinical indicators, pregnancy outcomes and relationship sFlt-1Objective:Analysis of early-onset severe preeclampsia and late onset severe preeclampsia of differences, as well as the relationship between sFlt-1 and clinical parameters to explore early-onset time of interruption of pregnancy.Method:Study on 60 cases of patients with severe preeclampsia, and is divided into early onset and late onset (bounded by 34 weeks), two sets of complications, clinical laboratory indicators, statistical analysis of the differences in perinatal outcomes. Result: Early-onset severe preeclampsia complicated a high proportion of gestational diabetes mellitus and chronic high blood pressure. A high proportion of newborns small for gestational age infants. Laboratory examination of liver enzyme is higher than late-onset group. No significant difference in the concentration of sFlt-1. sFlt-1 is positive correlation with 24h protein in urine, umbilical blood flow S/D and MAP. In the early-onset have positive correlation between sFlt-1 and serum uric acid in, and neonatal weight inversely correlated, and no obvious correlation in late-onset. Conclusion:Early-onset severe pre-eclampsia patients and patients with late-onset pathogenesis differences might exist.sFlt-1 is a key factors in neonatal weight, blood pressure, protein in urine. Close monitoring of sFlt-1 levels help to choose the best timing of interruption pregnancy.Part 4:The relationship between the level of sFlt-1 during pregnancy and postpartum recovery10 cases of severe preeclampsia return visit, the outcome of cases, patients with severe postpartum preeclampsia track.The recovery of patients with post-partum preeclampsia are different._Proteinuria and prenatal postpartum continued high levels of sFlt-1 related. Persistent proteinuria and hypertension after delivery is related with high level of sFlt-1 during pregnancy。High levels of sFlt-1 during pregnancy may cause future cardiovascular disease.