| Objective:To detect the expression of AT1-AA and sEng in preeclampsia patients in the secondtrimester of pregnancy,before and after delivery. Study the correlation between AT1-AAand sEng and explore their relationship with preeclampsia. Analyze the underlyingmechanism of AT1-AA involved in fetal growth restriction. Investigate the predictivevalue of AT1-AA and sEng in preeclampsia.Methods:Eighty-two pregnant women who underwent cesarean delivery from September2012to June2013in the First Affiliated Hospital of Soochow University were included in thisstudy. All cases attended our hospital for pregnancy check-ups regularly. Serum sampleswere collected from1-h50-g glucose challenge test between24and27weeks’gestation.The preeclampsia group included52cases, among which27cases were mildpreeclampsia and25cases were severe preeclampsia(EOSPE11cases, LOSPE14cases).Select30matched cases as control group. The general clinical features between studygroup and control group showed no significant difference. ELISA were used to detect theserum levels of AT1-AA and sEng in the second trimester of pregnancy,before and afterdelivery.The umbilical cord blood was also detected.Moreover,the correlating clinicalindexes were recorded and analyzed．Results:1．In the second trimester of pregnancy,the concentrations of AT1-AA in maternalperipheral blood were47.037±7.166,58.426±7.068,66.680±9.040(pg/mL)in normalpregnant women, MPE, SPE cases,respectively.The AT1-AA levels of MPE and SPEwere both significantly higher than that of control group(P<0.01). Besides, there wereapparently elevated levels of AT1-AA in the SPE cases compared with the MPEcases(P<0.01).The levels of sEng in MPE and SPE(11.326±1.257,12.620±1.816ng/mL,respectively) were both significantly higher than that of normal pregnant women (9.413±1.123ng/mL)(P<0.01).Significant difference was also found between MPE andSPE cases(P<0.01).2．Before delivery,the concentrations of AT1-AA and sEng in maternal circulationwere significantly higher in the preeclamptic cases (MPE134.293±11.777pg/mL,19.723±3.539ng/mL; SPE171.230±14.694pg/mL,24.923±4.233ng/mL, respectively)compared with the normal pregnant women(68.856±8.941pg/mL,11.837±2.588ng/mL,respectively)(P<0.01). The difference between MPE and SPE cases also has statisticalsignificance (P<0.01).3．After delivery,the maternal serum concentrations of AT1-AA were45.867±3.776,47.741±4.520,49.760±4.065(pg/mL) in control, MPE, SPE cases respectively. The levelsof sEng were9.467±1.279,10.037±1.505,10.744±1.265(ng/mL) in control, MPE, SPEcases respectively.There was a significant decrease in the concentrations of AT1-AA andsEng after delivery（P<0.05).4．The concentration of AT1-AA in umbilical cord blood was significantly higher inthe preeclamptic cases (MPE108.533±13.638pg/mL,SPE124.552±14.998pg/mL) comparedwith the normal pregnant women (63.113±11.207pg/mL)(P<0.05). The difference betweenMPE and SPE cases also has statistical significance (P<0.05).5．The serum levels of AT1-AA and sEng in early onset severe preeclampsia cases(180.133±6.658pg/mL,27.318±3.263ng/mL)were significantly higher than that of lateonset severe preeclampsia cases (165.145±5.842pg/mL,22.791±3.537ng/mL)(P<0.05)before delivery. The serum levels of AT1-AA and sEng in early onset severe preeclampsiacases (71.382±9.237pg/mL,13.527±1.889ng/mL)were significantly higher than that oflate onset severe preeclampsia cases (62.771±8.871pg/mL,11.935±1.772ng/mL)(P<0.05)in the second trimester of pregnancy.6．An apparent positive correlation existed between ATl-AA and sEng maternal serumlevels in preeclampsia cases (MPE r=0.830,SPE r=0.809,P<0.01).7．The serum ATl-AA levels of preeclampsia women were positively correlated withmean arterial pressure(MAP), S/D value and RI value of umbilical artery,24-hourproteinuria, creatinine and fibrinogen, while negatively correlated with the birth weight,the weight of placental and prothrombin time(P<0.05).8．An AT1-AA threshold of52.85(pg/mL) at24-27weeks yielded a sensitivity of 0.885, specificity of0.933, AUC0.907; A sEng threshold of10.41(ng/ml) at24-27weeksyielded a sensitivity of0.827, specificity of0.900, AUC0.864, respectively for subsequentonset of preeclampsia. Probability AT1-AA was prior to sEng in predicting preeclampsia.Conclusions：1．There was an abudant expression of AT1-AA and sEng in maternal serum ofpreeclampsia women. High level of AT1-AA was also seen in umbilical cord blood ofpreeclampsia cases. AT1-AA and sEng were both associated with disease severity.AT1-AA mediated sEng production involved in the pathogenesis of preeclampsia.2．The maternal AT1-AA may involved in the pathogenesis of renal dysfunction andfetal growth restriction in preeclampsia cases.3．An increase of AT1-AA and sEng levels was seen in the second trimester ofpregnancy in PE cases,besides,the level of EOSPE was higher than that of LOSPE.AT1-AA can be choosed as a biomarker to predict the occurrence of preeclampsia. |
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