| Objective:Preeclampsia is a common disease of obstetrics for systemic syndrome, accounts for about 3-5% in pregnant women, a typical sign for new onset of high blood pressure and proteinuria after 20 weeks gestation. Its high incidence and mechanism of ambiguity have made it the major challenge among perinatal medicine. The only certain and effective way to cure is the delivery of placenta, this suggests that the placenta is the major factor in the pathogenesis of preeclampsia. The mechanism of preeclampsia is not yet very clear, however, recent studies have shown that the placenta releases lots of anti angiogenesis factors(for example s Flt-1) and the synthesis of angiogenesis factors(for example Pl GF) decrease. These changes lead to systemic endothelial dysfunction, result in pregnancy-induced hypertension. Vascular endothelial growth factor(VEGF) and placental growth factor(Pl GF) through its receptors promote cell proliferation and angiogenesis which are secreted by trophoblastic cells. In VEGF and Pl GF 42% of amino acid sequence is the same, the synthesis of Pl GF is regulated by oxygen, and Pl GF only combine with receptor Flt-1. VEGF stabilizes endothelial cells in mature blood vessels and is particularly important in maintaining the endothelium in the kidney, liver, and brain. One of the major VEGF receptors is Flt1. s Flt-1 is a truncated splice variant of the membrane-bound VEGF receptor Flt-1. The relationship between s Flt-1 and preeclampsia patients is reported for the first time in 2003 by Maynard, etc. They confirm the increased plasma s Flt-1 m RNA level in patients with preeclampsia, 5 times higher than the normal pregnant women.Apelin is a bioactive multifunctional peptide, The multiple functions of apelin are mediated via G protein-coupled receptors known as APJ. The apelin gene encodes a 77 amino acid pre-pro-peptide, which is processed into several active forms. In the confirmed role of apelin system,the first one is the regulation of blood pressure. Apelin is considered to be local blood vessels regulator, studies have confirmed that the intravenous injections of apelin can cause vasodilation of immediacy. Apelin may directly activate L-Arg/NOS/NO way, and make vasodilatation agent NO concentration higher and cause vasodilation effect. And Pl GF in combination with its receptor through kallikrein-plasmakinin system on e NOS to play a role. Apelin has obvious expression in endothelial cells of kidney,apelin and APJ probably play a role in regulating blood flow to the kidneys, glomerular filtration rate, and renal tubular function.Gestational hypertension disease is a disease during pregnancy, Impaired endothelial function is one of the main causes, kidney is the most vulnerable organ to be damaged. This topic researched the peripheral blood and umbilical cord blood serum level of apelin and s Flt-1, the level of kidney function and their correlations in patients with preeclampsia,To explore their roles in the pathogenesis of preeclampsia and kidney damagement, and provide strong theory for clinical prevention and treatment of preeclampsia.Methods:1 The study subjects: This research is a case control study.(1) Random selection of 30 patients with preeclampsiain and delivery in obstetrics and gynecology of the Second Hospital of He Bei Medical University in May 2014 to December 2014.(2)the control group:Random selection of 20 healthy pregnant women who had prenatal examination and delivered in obstetrics and gynecology of the Second Hospital of He Bei Medical University in May 2014 to December 2014.20. Two groups of pregnant women are single pregnancy, no chronic high blood pressure, diabetes, heart disease, liver disease, kidney disease,autoimmune disease and so on.2 The experimental method:Pumping 4 ml peripheral venous blood of pregnant women before labor packing in 2 coagulant tubes, and 4 ml umbilical venous blood between the delivery of child and placenta. One tube of peripheral venous blood and umbilical venous blood within 4 h after collecting centrifugal separation of plasma(after 3000 RPM, 15 min),were in-80 ?refrigerator for determination the level of apelin and s Flt-1.Another tube of peripheral venous blood were timely detected renal function after separation of serum in clinical laboratory of the Second Hospital of He Bei Medical University.3 Statistical analysis:SPSS 13.0 software was used to analyze the datal; mean±standard deviation was used to show the measured data; t-test/t'-test and Pearson linear correlation analysis were involved in this research.Results:1 In the preeclampsia group,the peripheral venous blood serum apelin level is 74.65±15.20pg/ml, normal pregnant women: 45.68±10.06 pg/ml, two groups exist significant difference(p < 0.05); The serum s Flt-1 level in the preeclampsia group is 219.84±102.92pg/ml, normal pregnant women: 26.82±5.90pg/ml, two groups exist significant difference(p<0.05).2 The umbilical venous blood serum apelin level in the preeclampsia group(72.02±10.80pg/ml) is significantly higher than those in the normal group(49.31 ± 3.66pg/ml),There was significant difference between the preeclampsia group(101.70±46.18pg/ml) and the control group(26.82±5.89pg/ml)in s Flt-1 level.3 The serum urea level in the preeclampsia group(4.96±2.08 mmol/L) is significantly higher than that in the normal group(3.35±0.78 mmol/L),The serum creatinine level in the preeclampsia group(59.02±19.92 umol/L) is significantly higher than that in the normal group(44.43±9.63 umol/L). The serum Uric acid level in the preeclampsia group(380.95±95.79 umol/L) is significantly higher than that in the normal group(272.99±69.91umol/L).4 In the preeclampsia group, the serum apelin level correlate positively with the serum urea levels(r=0.588,P<0.05),correlate positively with the serum creatinine levels(r=0.461,P<0.05),correlate Positively with the serum Uric acid levels(r=0.371,P<0.05);in the preeclampsia group, the serum s Flt-1 level correlate positively with the serum urea levels(r=0.644,P<0.05),correlate positively with the serum creatinine levels(r=0.602,P<0.05), correlate Positively with the serum Uric acid levels(r=0.595,P<0.05).5 In the preeclampsia group, the serum apelin level is positively correlated with the serum s Flt-1 levels(r=0.636,P<0.05).Conclusion:1 In preeclampsia patients and healthy pregnant women serum apelin and s Flt-1 are the expression of a certain level; The umbilical cord blood apelin and s Flt-1 levels are higher in women with preeclampsia than normal pregnancy group; apelin, s Flt- 1 may play a role in the pathogenesis of preeclampsia.2 The blood urea nitrogen, creatinine, uric acid concentrations were significantly higher in Preeclampsia group than that of normal pregnant women, the change of these projects has important significance to the diagnosis of gestational hypertension disease and illness observation.in Preeclampsia patients the serum apelin level is positivelyrelated to the level of urea, creatinine, uric acid; in patients with preeclampsia the s Flt-1 is positively related to the level of urea, creatinine, uric acid levels, considered that apelin and s Flt-1 play a role in the development of renal injury.3 In preeclampsia women group the serum level of apelin is positively related to s Flt-1 in peripheral venous blood, considered that there may be a relationship between apelin and s Flt-1. The level of s Flt-1 increases, resulting in inhibiting the effect of Pl GF; Thereby it affects the kallikrein-plasmakinin system, and reduces the synthesis of NO; apelin,through L-Arg/NOS/NO way, can increase the NO level. It has the effects of diastole blood vessels and lower blood pressure. Besides, as an angiogenesis factor, apelin may play an inhibitory effect of occurrence and development of preeclampsia, both changes are likely to play in the process of the onset of preeclampsia. |
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