| Objective: Hypertensive disorder complicating pregnancy （HDCP) is apregnancy-specific disease involving multi-system disorders. The main feature of whichhas very complex pathophysiological mechanism is the body’s small blood vessels spasmand body system organ perfusion reduced. Its main clinical symptom is gestationalhypertension and proteinuria.As a serious threat to the safety of both mother and baby, the disease affectsprenatal and postnatal care seriously. It is one of the main causes of maternal andperinatal child morbidity and mortality.The research is to study the changes of vascular endothelial growth factor (VEGF)and von willebrand factor(vWF) in serum and placenta in hypertensive disordercomplicating pregnancy(HDCP),and investigate the expression and its correlation with24-hour urinary protein excretion in preeclampsia patients, so as to further clarify thecauses of the disease. We expect to explore an objective credible standard to evaluate thedegree of the disease development and assessment of prognosis as soon as possible. Inthat case, we will have a better and more effective guidance to guide clinical diagnosistreatment and prevention, by which could try our best efforts to guarantee themotherhood safety.Our aim is to reduce intrauterine growth retardation, cerebrovascular accident, liverand kidney dysfunction, placental abruption, premature birth, fetal death and othercomplications. So that it can achieve a relatively ideal pregnancy outcome to make benefit to the majority of HDCP patients.Methods: From obstetric department in Yan’an University Affiliated Hospital,wechosed77patients with Hypertensive disorder complicating pregnancy including24gestational hypertension patients,26mild preeclampsia patients and27severepreeclampsia patients. In addition,31normal pregnancy were involved in the study as thenormal control group. They had no significant difference between the two groups onmaternal age, gestational age, gravidity and mode of delivery. The levels of VEGF andvWF in serum were examined by enzyme-linked immunosorbent assay (ELISA); thelevels of VEGF and vWF in placental tissue were examined by the SPimmunohistochemistry; the24hour urinary protein excretion detected from thepreeclampsia patients was examined by Turbidimetric immrnoassay.The above resulting data were put into the SPSS19.0software analytical combiningwith Mean±Standard Deviation (x±s) expressed. The immunohistochemical detectionresults were statistically analyzed by image analysis.Results:①The levels of VEGF in serum and placenta in patients with hypertensivedisorder complicating pregnancy were decreased significantly compared with normalcontrol group. They were significant differences between them (P <0.01); the patientswith Mild preeclampsia has the lowest level. The levels of VEGF in the serum andplacental in severe preeclampsia group were higher than mild preeclampsia group, thedifferences were statistically significant (P <0.05); In preeclampsia patients, the levels ofVEGF in serum was positive correlated with that of placenta(r=0.309, P <0.05).②The levels of vWF in serum and placenta in the patients which were divided intothree groups (Gestational hypertension, Mild preeclampsia, Severe preeclampsia) weregradually increased, they were significant differences among them(P <0.05); The levelsof vWF in serum and placenta in gestational hypertension group had increasingtendency,which compared to the normal control group, but they had no significantdifference between them(P>0.05); The levels of vWF in serum and placenta in the Mildand Severe preeclampsia group were obviously higher than those in the normal controlgroup(P <0.05),and the more severe the disease, the higher the levels; In preeclampsiapatients, the levels of vWF in serum was positive correlated with that of placenta(r= 0.562, P <0.01).③In preeclampsia patients, levels of vWF in serum and the24hour urinary proteinexcretion was positively correlated，and it has liner regression relationship betweenthem.(r=0.748，R2=0.56,F=31.722,P＜0.01)Conclusion:Low-levels of VEGF in patients with hypertensive disordercomplicating pregnancy may affects their placental vascrlar network formation andgrowth and development, which leads to differentiation、proliferation and invasiondysfunction of trophoblast cells. Because of this, it leads to shallow placentalimplantation. Therefore the placenta had not rich blood supply, which resulted inplacental hypoxia and ischemia, vascular endothelial injury. Eventually, vWF releasedinto serum, increasing the content of vWF in serum. Thus it affirms the role of the theoryof vascular endothelial injury in pregnancy hypertension disease causes. This studymakes a beneficial exploration to further clarify the cause of this disease.When hypertensive disorder complicating pregnancy develops to severepreeclampsia, the internal environment of patients would in serious ischemia anoxic,which in turn may affect the expression of VEGF in serum and make its expressionincreased. It will increase vascular permeability, plasma protein extravasation, by whichcan cause urine protein. In addition, the patients with hypertensive disorder complicatingpregnancy are characterized by systemic small artery spasm, which can cause renal bloodflow to be reduced, result in diffuse swelling of the glomerular capillary endothelial cells,and then lead to vascular endothelial cell injury. Eventually, it increases vascularpermeability, results in proteinuria.In preeclampsia patients, the levels of VEGF in serum was positive correlated withthat of placenta; the levels of vWF in serum was positive correlated with that of placentatoo. In preeclampsia patients, levels of vWF in serum and the24hour urinary proteinexcretion was positively correlated, it changes along with each other. There is importantsignificance to monitor the changes of VEGF and vWF in serum in hypertensive disordercomplicating pregnancy. The change of it is an important indicator for judging diseaseseverity and placental function of HDCP patients initially, in addition, it can estimatesthe degree of kidney damage preoiminarily. Furthermore, it can be an important significant indicator for guiding clinical diagnosis, treatment and prevention.Additionally, the study laid the foundation for seeking new forecast biochemicalindicators in patients with hypertensive disorder complicating pregnancy. However, thespecific pathogenesis of the disease had not been determined. The number of samples inthis study is not sufficient. This requires us to work harder in-depth study. |
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