妊娠期高血压疾病患者肾素-血管紧张素-醛固酮系统变化情况及可能的调控机制

Changes in renin-angiotensin-aldosterone system and its possible regulatory mechanism in hypertensive disorder complcating pregnancy

目的分析妊娠期高血压疾病患者肾素-血管紧张素-醛固酮系统(RAAS系统)变化情况及可能的调控机制。方法选取2020年7月—2021年9月吉林省妇幼保健院收治的80例(有21例在该院进行孕前备孕检查为孕前组)妊娠期妇女为研究对象,其中合并妊娠期高血压疾病孕妇18例为妊娠期高血压疾病组、正常孕妇62例为正常妊娠组。检测所有研究对象肾素、血管紧张素Ⅱ及醛固酮水平。比较正常妊娠组、妊娠期高血压疾病组及孕前组肾素、血管紧张素Ⅱ及醛固酮水平的差异;比较妊娠期高血压疾病组孕妇不同孕周肾素、血管紧张素Ⅱ及醛固酮水平的差异,并与正常妊娠组不同孕周进行比较,分析其变化的调控机制。结果正常妊娠组、妊娠期高血压疾病组肾素、血管紧张素Ⅱ及醛固酮水平均高于孕前组,差异有统计学意义(P<0.05)。妊娠期高血压疾病组孕早期肾素水平与正常妊娠组比较,差异无统计学意义(P>0.05),到孕20周后开始下降,但仍高于孕前水平,与正常妊娠组比较,差异有统计学意义(P<0.05);妊娠期高血压疾病组血管紧张素Ⅱ水平明显也高于孕前水平,并持续升高,到孕28周左右略有下降,但与正常妊娠组比较,差异无统计学意义(P>0.05);妊娠期高血压疾病组孕早期醛固酮水平与正常妊娠组比较,差异无统计学意义(P>0.05),但随着孕周增加,醛固酮水平下降,从孕20周开始到孕晚期与正常妊娠组比较,差异有统计学意义(P<0.05),孕晚期其水平下降至孕前水平。结论妊娠期高血压患者的RAAS系统指标与正常妊娠孕妇相比出现下降趋势,不同孕周妊娠期高血压疾病患者RAAS系统指标变化明显,随着患者肾素分泌增多,导致患者血管紧张素Ⅱ水平出现升高趋势,而血管紧张素Ⅱ可以刺激醛固酮的产生,导致患者血压升高。

Objective To analyze the changes and possible regulatory mechanisms of the renin-angiotensin-aldosterone system(RAAS system)in hypertensive disorder complicating pregnancy.Methods 80 women in pregnancy were admitted to Jilin Women and Child Health Hospital from July 2020 to September 2021 were selected as the study subjects(21 women who had pre-pregnancy examinations were pre-pregnancy group),including 18 patients with hypertensive disorder complicating pregnancy were HDCP group,and 62 normal pregnant women were normal pregnancy group.The levels of renin,angiotensin Ⅱ and aldosterone were examined in all study subjects.To compare the different levels of renin,angiotensin Ⅱ and aldosterone in normal pregnancy group,HDCP group and pre-pregnancy group;to compare the different levels of renin,angiotensin and aldosterone in differentgestational weeks of HDCP group,meanwhile to compare the levels between the HDCP group and the normal pregnancy groupin different gestational weeks.To analyze the changes and possible regulatorymechanism of RAAS.Results The levels of renin,angiotensin Ⅱ andaldosteronein normal pregnancy group and HDCP group were higher than those in pre-pregnancy group,the difference was statistically significant(P<0.05);to compared the levels of renin inearly stage of pregnancy between the normal pregnancy group and HDCP group,there was no statistically significant(P>0.05),but it was decreased in HDCP group after 20 weeks,although that were still higher than the pre-pregnancy levels,the difference was statistically significant when compared with the normal pregnancy group(P<0.05);the levels of angiotensin Ⅱ was also significantly higher in HDCP group than the prepregnancy group,and continued to rise until about 28 weeks pregnant,that was slightly decreased,but there was no statistically significantly between the normal pregnancy group and HDCP group(P>0.05);to compared the levels of aldosterone in early pregnancy,there was no statistically significant between HDCP group and the normalpregnancy group(P>0.05),but with the gestational weeks increasing,aldosterone secretion decreases,there was statistically significantly between HDCP group and the normal pregnancy group from 20 weeks to late stage of pregnancy(P<0.05),and the decline in late pregnancy can be consistent with non-pregnancy group levels.Conclusion The levels of RAAS were decreased in HDCP group compared with the normal pregnancy group,the levels of RAAS changed significantly in different gestational weeks of HDCP group,as renin secretion increases in patients,resulting inan increased trend in the angiotensin Ⅱ of patients,and the angiotensinⅡcan stimulatealdosterone secretion,that causes the patient’s blood pressure to rise.