| Objective: Hypertensive disorders in pregnancy(HDCP) is an idiopathic disease during pregnancy, which could cause multiple organ dysfunction or failure, it is the second leading cause of maternal mortality. The incidence of it in China is between 9.4 and 10.4%, and in foreign countries the incidence is between 7 and 12%. HDCP has caused 7.1/100000 maternal deaths. Numerous studies show that the basic pathological changes of hypertensive disorders in pregnancy is the systemic vascular spasm caused by the endothelial cells damaged and the systemic inflammation, it is a serious threat to maternal and child health. The disease caused the vascular endothelial dysfunction, reduced the levels of vasodilator(NO, PGI2), and elevated the levels of vasoconstrictor factor(ET, TXA2). It caused patients with different degrees of vascular endothelial cell damage, leading to multi-system, multi-organ damage and failure, which could lead to convulsions, coma, placental abruption, fetal distress, fetal death, DIC and so on. The etiology of hypertensive disorders in pregnancy has not been fully elucidated, it may be related to a variety of factors, such as the mother, the fetus and the placenta. including poor placenta formation, oxidative stress, poor immune adaptation, genetic predisposition, nutritional deficiencies and other factors. The present study agreed that the placental ischemia and hypoxia is the initial cause of hypertensive disorders in pregnancy. The pathological changes cased the release of inflammatory cytokines, which lead to oxidative stress and vascular endothelial damage. Apelin is a vasoactive peptide discovered recently, it is an endogenous ligand of the G protein-coupled receptor APJ. It plays an important role in the regulation of inflammatory response, immune system, water and salt metabolism, maintenance of vascular endothelial functions and so on. It dilates blood vessels, improve myocardial contractility, enhanced insulin sensitivity, and so on. And chemerin is another new diacovered recently, its nature is a chemoattractant protein which involved in the pathogenesis of hypertensive disorders in pregnancy. It could regulated the initiation and resolution of inflammation, promote adipocyte differentiation and maturation, immune response, enhance insulin resistance and regulated the glucose and fat metabolism, and so on. We could investigate the development of the hypertensive disorders in pregnancy by observing the expression of the two factors in the human placenta, then find a new way to prevent and treat hypertensive disorders in pregnancy.Methods: We randomly selected 90 cases of obstetric patients with hypertensive disorders in pregnancy as study group at the People’s Hospital of xingtai from March 2013 to March 2014, of which there are 30 case with gestational hypertension, 30 case with mild preeclampsia, 30 case with severe preeclampsia, and at the same period, we randoming select 30 cases with normal pregnancy as control group. We monitor the expression of Apelin protein and Chemerin protein by using immunohistochemistry(SP method) and quantitative reverse transcription polymerase chain reaction(RT-PCR), which could help us to understand the causes of hypertensive disorders in pregnancy and intervene the perinatal outcome.Result:1 Apelin and Chemerin mainly expressed in the syncytiotrophoblast of the placenta, There was no difference between age, gestational age,and body mass index.2 The expression of the apelin protein in the gestational hypertension group was significantly lower than that in the contorl group(P<0.01), and it was significantly lower than that in the mild preeclampsia group and the severe preeclampsia group(P<0.01,P<0.01), and with the severity of the disease, the expression of the apelin protein decreased. The apelin protein in the mild preeclampsia group and the severe preeclampsia group was significantly lower than that in the gestational hypertension group(P<0.01,P<0.01), and there was difference between the mild preeclampsia group and the severe preeclampsia group(P<0.05).3 The chemerin proteins expressed in all groups, and with the severity of the disease, the expression of the apelin protein increased. The expression of the chemerin protein in the Study group was higher than that in the contorl group(P<0.05,P<0.05,P<0.05), The chemerin protein in the mild preeclampsia group and the severe preeclampsia group higher than that in the gestational hypertension group(P<0.01,P<0.01). There was difference between the mild preeclampsia group and the severe preeclampsia group(P<0.05).4 Comparison between the placental weigt and birth weight4.1 The placental weight was lower than that in the comparison between the placental weight and birth weight in the other group(P<0.05,P<0.05,P<0.05), and with the severity of the disease, the weight of he placental weight decreased.4.2 The birth weight was lower than that in the other group(P<0.05, P<0.05,P<0.05), and with the severity of the disease, the weight of he birth weight decreased.Conclusion:1 The levels of Apelin protein expression is low in the placental tissue of patients with hypertensive disorders in pregnancy. It may play a role in the development of the hypertensive disorders in pregnancy. With the severity of the disease, it decreased,which indicate that it might negatively correlated with the severity of the disease.2 The expression of the chemerin protein is higher in gestational hypertension group. It may led to the diseases. With the severity of the disease, it increased, which indicate that it might positively correlated with the severity of the disease.3 The role of the Apelin / Chemerin and their corresponding receptors in the development of the hypertensive disorders in pregnancy needs further study.4 We could predict the occurrence of hypertensive disorders in pregnancy by detecting Apelin/Chemerin expressions. and find a new drug to adjust Apelin/Chemerin synthesis. Through it we could open new ideas and fing new targets for the treatment of hypertensive disorders in pregnancy. |
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