| Hypertensive disorder complicating pregnancy is a pregnancy-specific disease, which is a major cause of maternal and fetal morbidity and mortality. Its etiology is as yet unknown. The frequency of hypertensive disorder complicating pregnancy is 9.4% in China and 7-12% in fremdness. But up to present, the cause and the underlying pathogenic mechanism is still unknown. Obstetricians have paid considerable attentions on hypertensive disorder complicating pregnancy, but so far, the reasons of hypertensive disorder complicating pregnancy have not been identified. So, it is important to find the pathogenesis of hypertensive disorder complicating pregnancy.The imbalance of immune system and the damage of vascular endothelial cell play a important role in hypertensive disorder complicating pregnancy. They may the common approach by which all kinds of factors result in hypertensive disorder complicating pregnancy. Interleukin 6(IL-6) and Tumor Necrosis Factor-alpha (TNF- α ) which are inflammatory medium and immunity regulator are important to the I production and regulation in vascular endothelial cell. IL-6 is a 21-26kD protein and a multi-functional cytokine that induces a number of biologicalresponses and play a role in cell growth regulation, immune host defense, angiogenesis and others. It is produced by many different cell types including monocytes, fibroblasts, endothelial cells, glial cell. TNF- a is a 17 kD, 157 amino acid protein that is secreted by macrophages, monocytes, neutrophils, T-cell, NK-cell following their stimulation by bacterial lipopolysaccharides . TNF- a also enhances phagocytosis and cytotoxicity in neutrophilic guanulocytes and also modulates the expression of many other proteins. TNF- a has been suggested to play a pro-inflammatory role. TNF alpha is the primary mediator of immune regulation. The biosynthesis of TNF alpha is tightly controlled being produced in extremely small quantities in quiescent cells, but is a major secreted factor in activated cells.It is generally agreed that the role of cytokine is important in vascular endothelial cell. It is believed that IL-6 and TNF- a are closely related with the hypertensive disorder complicating pregnancy. But the underlying pathogenic mechanism has not been well defined yet.Objective: This investigation was design to evaluate the relationship between maternal serum IL-6, TNF-a and pre-eclampsia so as to help us find the cause and the underlying pathogenic mechanism. At the same time, the aim of this study was to investigate the changes in serum levels IL-6^ TNF- a in women with pre-eclampsia and to evaluate their clinical significance in the pathogenesis of pre-eclampsia.Materials and Methods: The study population consisted of in-patient whoadmitted to the Third Affiliated Hospital of ZhengZhou University between March 2004 and December 2004(primigravida and single pregnancy). Subjects were divided two groups: ?The normal group(n=30,average age is 27.8±2.4 years old, average gestational age is 37.1±1.9 week).(2)The pre-eclampsia group (n=53,average age is 28.1±2.2 years old, average gestational age is 36.2±2.1 week). The pre-eclampsia group was divided two groups, mild pre-eclampsia(27 cases) and severe pre-eclampsia(26 cases). All cases did not using antibiotic before takematernal serum. Body temperature is below 37.5°C . Heart rate of pregnant woman is below 100 per minute. White blood count is below 15xlO9/L. All cases have not regular uterus contraction and hypertension in family history. According to the diagnostic standard (OBSTETRICS AND GYNECOLOGY edited by Lejie, the sixth edition).Two groups had no other complications of pregnancy . We used a radioimmunoassay to quantitate maternal serum IL-6 -. TNF- a levels. All experimental data were processed by SPSS 11.0.Results : 1.Maternal serum IL-6(220.08±31.82pg/ml) , TNF- a(1.79±0.25ng/ml) in preeclampsia group were significantly higher than maternal serum IL-6(114.63±14.63pg/ml)> TNF- a (1.16±0.13ng/ml) in normal group(P<0.05). 2. Maternal serum IL-6(246.27±2.76pg/ml), TNF- a (1.99±0.17ng/ml) in severe pre-eclampsia group were significantly higher than maternal serum IL-6(119.13±20.79pg/ml) , TNF- a (1.60±0.14ng/ml) in mild pre-eclampsia group(P<0.05). 3. maternal serum IL-6, TNF- a in mild pre-eclampsia group were significant higher than those of the normal group (P<0.05).4.the levels of IL-6 and TNF- a are closely related with the pre-eclampsia.Conclusions:1. The imbalance of immune system and the damage of vascular endothelial cell are the taches of hypertensive disorder complicating pregnancy. In pre-eclampsia, increasing IL-6 stimulate the platelet-derived growth factor (PDGF) creating and vascular cell adhesion molecule (VCAM) expressing, and that restrain vascular endothelia prostaglandin, which constrict the blood vessel and damage vascular endothelial cell.2. In pre-eclampsia, increasing TNF-a widen vascular endothelial cell gap, that make decidual cell and umbilical vein endothelial cell secrete thromboxane(TXA2) and increase plasminogen activator inhibitor. That involved in the pathogenic mechanism.3. The concentration of maternal serum IL-6 > TNF- a correlates positively with the degree of pre-eclampsia. The level of maternal serum IL-6, TNF-a is increasedin pre-eclampsia, which damage the vascular endothelial cell , then IL-6^ TNF- a are synthesized in damaged vascular endothelium. This is a malignant circulation .4. Measuring the level of IL-6% TNF-a make us know well the state of pre-eclampsia , and controlling the concentration of maternal serum IL^ TNF- a alleviate the pre-eclampsia aggravation. That is significant to control pre-eclampsia.
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