| BackgroundHypertensive disorder complicating pregnancy is a kind of multiple organ dysfunctionsyndrome after20weeks of pregnancy, which clinical manifestations are diverse, and seriousperson can accompany hair neurological symptoms and signs. Known as preeclampsiaeclampsia, is one of the main causes of maternal and neonatal death, and is also risk factor ofsecondary to maternal cardiovascular and cerebrovascular diseases, diabetes and descendantsof tyre origin of adult disease. Its pathogenesis is not yet fully elucidated. But there isconsensus that the base damage and dysfunction of vascular endothelial cells of hypertensivedisorder complicating pregnancy is not only the basic of a series change of pathological andphysiological, but also the central link multiple pathogenic factors that mediates itspathogenesis.A growing body of research suggests that preeclampsia eclampsia pregnant women oftenhave abnormal lipid metabolism, the role of vascular injury with triglyceride (TG) and lowdensity lipoprotein cholesterol (LDL-C) increased significantly, and high density lipoproteincholesterol (HDL-C) which has the function of vascular protection decreased significantly.The abnormal lipid metabolism occurred, leading to increased enhancement and toxicityproduct of oxidative stress, resulting in injury of vascular endothelial cells, a series ofpathological and physiological changes of preeclampsia, which is closely related to thedisease. At present, although the occurrence of hypertensive disorder complicating pregnancyand disorder of lipid metabolism is closely related to this point of view has been widelyrecognized, but the change of blood lipid components in still exist certain differences,epidemiological analysis it was necessary to conduct a large sample of normal pregnancy.Pregnant women and the change of blood lipid metabolic diseases in pregnant women withgestational hypertension, is provided basis and severity for clinical predict the occurrence ofhypertensive disorder complicating pregnancy. In recent years, more and more researches show that, the incidence of inflammation isinvolved in preeclampsia. Pre-eclampsia is a parent of an excessive inflammatory reaction ofpregnancy. Lipoprotein associated phospholipase A2(Lp-PLA2) is an newly discoveredinflammatory marker, the R92H polymorphisms has type3genotypes that are RR type, RHtype and HH type. The dominance of Lp-PLA2in the plasma of the role is to connect to theLDL through the apolipoprotein B, then LDL on lecithin into oxygen Lp-PLA2oxidation andhydrolysis of lecithin, lecithin generated immediately lysophosphatidylcholine and oxidizedfree fatty acid, and the latter two are strong proinflammatory mediators, which can stimulatethe adhesion molecules and cytokine production, resulting in injury and dysfunction ofvascular endothelial cells. Due to the disorder of Lp-PLA2is closely related with lipidmetabolism, and can induce inflammatory reaction leads to the damage of vascularendothelial cells, we hypothesize that it may be closely related to the occurrence andpreeclampsia.In clinical work, we found that, the nervous system dysfunction in patients withhypertension in abnormal blood pressure or changes, such as hypertensive encephalopathy.But in clinic, some patients with preeclampsia in blood pressure did not change significantlyin the case is still possible eclamptic convulsions. Preeclampsia eclampsia factor especiallysudden onset, and once the disease requires rapid medical intervention to prevent its adverseeffects on maternal and fetus. Therefore this topic through the data and blood specimens werecollected from clinically normal pregnant women and pregnant women with preeclampsiawere investigated, to investigate the possible mechanisms of the pathogenesis of preeclampsiaand eclampsia.Objective1. The study of the level of lipoprotein associated phospholipase A2(Lp-PLA2) in theserum of pregnant women with hypertensive disorder complicating pregnancy, is to explorethe relationship and clinical significance between Lp-PLA2and hypertensive disordercomplicating pregnancy.2. To investigate the association of lipoprotein associated phospholipase A2gene(Lp-PLA2) polymorphism with pre－eclampsia and serum Lp-PLA2levels．3. To investigate The relationship between preeclampsia and the methylation status ofMTHFR genes in placenta tissue and serum. Results1. Compared with the control group of normal pregnancy, in pregnancy inducedhypertension group, mild preeclampsia group, severe preeclampsia group,the concentrationof Lp-PLA2were significantly increased (P <0.05). Lp-PLA2was positively correlated withhypertensive disorder complicating pregnancy (rs=0.6022, P=0.0133). In patients withpreeclampsia, the concentration of plasma Lp-PLA2was positively correlated with TC, TGand LDL-C, while was the negative related with HDL-C. Excluding confounding factorsLp-PLA2was independently associated with preeclampsia.2. Compared with RR genotype， the H allele frequencies of Lp-PLA2gene R92Hpolymorphism and the distribution of RH+HH genotype was significantly different betweenpre-eclampsia patients and control subjects．Plasma Lp-PLA2levels in patients with RH+HHgenotypes were lower than patients with RR genotype in pre-eclampsia cases．Pre-eclampsiapatients had higher levels of TG，TC and HDL than control subjects.3. The level of Hcy in pregnancy hypertension significantly increased than that in controlgroup (P<0.05); MTHFR methylation of pregnancy hypertension samples and normalpregnant samples were26.8%(34/127)、15.2%(20/132) respectively showing a significantdifference(P<0.05).Conclusion1. Lp-PLA2is one of the risk factors of patients with preeclampsia, which has greatsignificance in predicting risk and treatment of pre-eclampsia.2. The RH+HH genotype of Lp-PLA2gene R92H may be related to the occurrence ofpre-eclampsia and elevate the genetic risk of developing pre-eclampsia together withLp-PLA2disorder．3. The high methylation status of MTHFR was related to the occurrence of pre-eclampsiaand increase the genetic risk of developing pre-eclampsia together with Hcy disorder．... |
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