| Hypertensive disorder complicating pregnancy is a pregnancy-specific disease, which is a major cause of maternal and fetal morbidity and mortality. Its etiology is yet unknown. The frequency of hypertensive disorder complicating pregnancy is 9.4% in China and 6.4%-7.0% in foreign country. But up to present, the cause and the underlying pathogenic mechanism is still unknown. Obstetricians have paid considerable attention to hypertensive disorder complicating pregnancy, but 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 activation and damage of vascular endothelial cell play an important role in hypertensive disorder complicating pregnancy. They may be the common approaches by which all kinds of factors result in hypertensive disorder complicating pregnancy. Leptin and Tumor Necrosis Factor-alpha (TNF-α) which are inflammatory medium and immunity regulator are important to the production and regulation in vascular endothelial cell. Leptin is a 16 kDa, 167 amino acid protein that is secreted by fat cell and is the product of fat gene. Leptin is a kind of neuroendocrine hormone which play an important role in regulating diet, body weight and energy metabolism. TNF-αis a 17 kDa,157 amino acid protein that is secreted by macrophages,monocytes,neutrophils,T-cell,NK-cell following their stimulation by bacterial lipopllysaccharides. TNF-αalso enhances phagocytosis and cytotoxicyty in neutrophilic guanulocytes and also modulates the expression of many other proteins. TNF-αhas been suggested to play a pro-inflammatory role. TNF-αis the primary mediator of immune regulation. The biosynthesis of TNF-αis tightly controlled and 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 leptin and TNF-αare closely related with the hypertensive disorder complicating pregnancy. But the underlying pathogenic mechanism especially the relation between leptin and TNF-αhas not been well defined yet. ObjectiveThis study was designed to observe the changes of leptin and TNF-αlevel, and the relationships with HDCP; and to evaluate the relationships between leptin and TNF-α, So we could get the evidence to studying the mechanisms of HDCP, and could monitor the occurrence and development of HDCP and find the new approach of therapy.Methods:The study population consisted of 80 in-patients between August 2005 and February 2007.(Primigravida and single pregnancy). The control group consisted of 32 women with normal pregnancy, The study group consisted of 48 women with HDCP. The HDCP group is divided into three groups, GH(20 cases) , MP 15 cases and SP 13 cases . The serum levels of leptin and TNF-αwere measured by RIA (radioimmunoassay). All data were analyzed with SPSS11.0 software , including t-test, ANOVA and linear correlation.Result:1 Serum concentrations of leptin were higher than those of controls(13.06±4.08 vs 8.79±2.11μg/L,P<0.05).2 Maternal serum of leptin increased gradually with the development of HDCP, GH:10.08±1.67μg/L,MP: 12.32±1.97μg/L SP:18.51±2.91μg/L,The pre-eclampsia were significantly higher than that in the GH.3 The concentration of maternal serum leptin were correlated with the SBP and the DBP of the study population. SP group is more significative (r=0.85,0.86) P<0.05; The maternal serum Creatinine and Uric acid of the group with HDCP is higher than those of controls, and were correlated with the maternal serum of leptin,. SP group is also more significative (γ=0.83,0.84).4 Serum concentrations of TNF-αwere higher than those of controls(1.56±0.31 vs 1.26±0.31μg/L,P<0.05).5 Maternal serum TNF-αincreased gradually with the HDCP degree, GH:1.32±0.15μg/L,MP:1.59±0.17μg/L﹑SP:1.91±0.28μg/L, The pre-eclampsia were significantly higher than that in the GH. The difference is significant(P<0.05).Serum concentrations of TNF-αin Gestational hypertension group are higher than those in normal pregnancy group, but there is no significance ( P>0.05) .6 The levels of serum leptin were positively correlated with those of serum TNF-αin HDCP group(γ=0.87,P<0.01)Conclusions:1 The levels of serum leptin and serum TNF-αincreased significantly in HDCP, and get higher with development of HDCP, leptin and TNF-αare suspected to play an important role in development of HDCP.2 The levels of serum leptin were positively correlated with those of serum TNF-αgroup, it hinted both the two cell factors may be interrelated in the occurrence and development of HDCP.3 Leptin and TNF-αare important cell factors during the course of the inflammation, they are both closely related with HDCP. We can infer the inflammation may be the potential cause of HDCP.4 Measuring the levels of leptin and TNF-αcan help us to learn the serious degree of hypertensive disorder complicating pregnancy, and it can forecast the development and the prognosis of HDCP. But it needs the study of bigger sample to confirm that conclusion.
|
PDF Full Text Request