Preeclampsia is an idiopathic multisystem disorder specific to human pregnancy. This study used proteomic analysis of cerebrospinal fluid (CSF) to identify protein biomarkers characteristic of preeclampsia and related...Preeclampsia is an idiopathic multisystem disorder specific to human pregnancy. This study used proteomic analysis of cerebrospinal fluid (CSF) to identify protein biomarkers characteristic of preeclampsia and related to its severity. Study design: CSF was collected from women diagnosed clinically with severe preeclampsia (sPE: n=7), mild preeclampsia (mPE: n = 8), and normotensive controls (CRL: n = 8). Samples were subjected to proteomic analysis using surface-enhanced laser desorption/ionization time-of-flight (SELDI- TOF)mass spectroscopy. A discriminative proteomic biomarker profile was extracted by applying Mass Restricted analysis, and a Preeclampsia Proteomic Biomarker (PPB) score developed based on the presence or absence of four discriminatory protein peaks in individual CSF SELDI tracings. In-gel tryptic digests, Western blot analysis, on-chip immunoassays, ELISA, and spectral analysis were used to identify the biomarkers composing the PPB score. Results: PPB score distinguished patients with a clinical diagnosis of sPE from mPE and CRLs. (PPB median [range]: sPE: 4 [0- 4] vs mPE: 1 [0- 1] vs CRL: 0 [0- 0]; P < 0.001). PPB scores were unaffected by parity, magnesium seizure prophylaxis, CSF leukocyte counts, and total protein content. Proteomic identification techniques matched the discriminatory protein peaks to the α - and β - hemoglobin chains. ELISA confirmed that women diagnosed clinically with sPE had significantly higher CSF hemoglobin concentrations than women with mPE or CRL (median [range]: sPE:6.6 [0.0- 10.3] μ g/mL vs mPE: 0 [0- 1.3] μ g/mL vs CRL: 0 [0- 0] μ g/mL; P < 0.001). Conclusion: Proteomic analysis of CSF can accurately distinguish sPE from both mPE and CRL. Patients with sPE have nanomolar amounts of free hemoglobin in their CSF. Further studies are needed to confirm these observations and determine their physiologic implications.展开更多
重度子痫前期是妊娠期高血压疾病中较严重的一种类型，目前的治疗方法主要是给予解痉、降压、镇静、利尿［1］，硫酸镁为解痉治疗的首选药物［2］，在负荷剂量硫酸镁2．5～5 g 后1～2 g ／h静滴维持，24 h 总量25～30g［3］，这就导致...重度子痫前期是妊娠期高血压疾病中较严重的一种类型，目前的治疗方法主要是给予解痉、降压、镇静、利尿［1］，硫酸镁为解痉治疗的首选药物［2］，在负荷剂量硫酸镁2．5～5 g 后1～2 g ／h静滴维持，24 h 总量25～30g［3］，这就导致重度子痫前期患者一天之中有10～16 h 都在输液，有时甚至是整夜，再加上持续心电监护是监测血压的主要手段，输液和心电监护对重度子痫前期患者的睡眠时间及质量均会产生影响，加上心理、营养、体位、预见性护理能力等因素继而影响到血压控制，可导致病情不稳定。本研究将2012年1月—2014年6月收治的符合条件的96例重度子痫前期孕妇分为干预组及对照组，通过对入院第2日夜间血压谷值血压平均值及早晨峰值血压平均值进行对比，发现干预组夜间血压谷值血压平均值及早晨峰值血压平均值均显著低于对照组，且控制在目标血压范围内，现报告如下。展开更多
There is considerable variation in the expression of severe preeclampsia. Our purpose was to determine if this is associated with maternal race or ethnicity. Study design: Individual chart review was performed for wom...There is considerable variation in the expression of severe preeclampsia. Our purpose was to determine if this is associated with maternal race or ethnicity. Study design: Individual chart review was performed for women diagnosed with severe preeclampsia at a tertiary care center from 1993 to 2003. Demographic, clinical, and lab findings from diagnosis (Dx) to 6 weeks’ postpartum (PP) were documented. Data were compared between Caucasian, African American, and Hispanic women. Data were presented for the total cohort if no significant difference was found. Results: We evaluated 473 pregnancies: 201 (Caucasian), 216 (African American), and 56 (Hispanic). Groups had similar baseline characteristics: chronic hypertension (HTN), diabetes, and initial antenatal blood pressure (mean BP 118/68). Caucasian women were older (27 vs 24 yrs), more likely nulliparous (63 vs 49% ), and had more multiple gestations (9 vs 1.5% ), P < .002 for each. African Americans had less epigastric pain (7.4 vs 10% ) and nausea (2.3 vs 5% ), P < .05 for each. Platelets < 100,000/μ L and asparate aminotransferase >60 mg/dL were more common in Caucasian women at Dx (9 vs 12% , 11 vs 21% ) and at delivery (14 vs 24% , 19 vs 34% ), P < .05 for each. No difference in severe proteinuria was seen. African Americans had more severe HTN at both Dx (44.9 vs 30% ) and peak BP (85 vs 67% ), and required more antihypertensive Rx intrapartum (12 vs 6% ), PP (38 vs 12% ), and at discharge (35 vs 21% ), P < .03 for each. Hispanics presented later (36 vs 34.6 weeks) and had less severe HTN (27 vs 40% ), P < .04 for each. BP on DC was not different between groups. Caucasian women had more hemolysis, elevated liver enzymes and low platelets syndrome (29 vs 19% , P = .01). Eclampsia, intrauterine fetal demise, intrauterine growth restriction, abruption, PP preeclampsia, and recurrent preeclampsia were similar between groups. Conclusion: African American women with severe preeclampsia demonstrate more severe hypertension and required more antihypertensive Rx, while Caucasian women have more frequent hemolysis, elevated liver enzymes and low platelets syndrome.展开更多
文摘Preeclampsia is an idiopathic multisystem disorder specific to human pregnancy. This study used proteomic analysis of cerebrospinal fluid (CSF) to identify protein biomarkers characteristic of preeclampsia and related to its severity. Study design: CSF was collected from women diagnosed clinically with severe preeclampsia (sPE: n=7), mild preeclampsia (mPE: n = 8), and normotensive controls (CRL: n = 8). Samples were subjected to proteomic analysis using surface-enhanced laser desorption/ionization time-of-flight (SELDI- TOF)mass spectroscopy. A discriminative proteomic biomarker profile was extracted by applying Mass Restricted analysis, and a Preeclampsia Proteomic Biomarker (PPB) score developed based on the presence or absence of four discriminatory protein peaks in individual CSF SELDI tracings. In-gel tryptic digests, Western blot analysis, on-chip immunoassays, ELISA, and spectral analysis were used to identify the biomarkers composing the PPB score. Results: PPB score distinguished patients with a clinical diagnosis of sPE from mPE and CRLs. (PPB median [range]: sPE: 4 [0- 4] vs mPE: 1 [0- 1] vs CRL: 0 [0- 0]; P < 0.001). PPB scores were unaffected by parity, magnesium seizure prophylaxis, CSF leukocyte counts, and total protein content. Proteomic identification techniques matched the discriminatory protein peaks to the α - and β - hemoglobin chains. ELISA confirmed that women diagnosed clinically with sPE had significantly higher CSF hemoglobin concentrations than women with mPE or CRL (median [range]: sPE:6.6 [0.0- 10.3] μ g/mL vs mPE: 0 [0- 1.3] μ g/mL vs CRL: 0 [0- 0] μ g/mL; P < 0.001). Conclusion: Proteomic analysis of CSF can accurately distinguish sPE from both mPE and CRL. Patients with sPE have nanomolar amounts of free hemoglobin in their CSF. Further studies are needed to confirm these observations and determine their physiologic implications.
文摘重度子痫前期是妊娠期高血压疾病中较严重的一种类型，目前的治疗方法主要是给予解痉、降压、镇静、利尿［1］，硫酸镁为解痉治疗的首选药物［2］，在负荷剂量硫酸镁2．5～5 g 后1～2 g ／h静滴维持，24 h 总量25～30g［3］，这就导致重度子痫前期患者一天之中有10～16 h 都在输液，有时甚至是整夜，再加上持续心电监护是监测血压的主要手段，输液和心电监护对重度子痫前期患者的睡眠时间及质量均会产生影响，加上心理、营养、体位、预见性护理能力等因素继而影响到血压控制，可导致病情不稳定。本研究将2012年1月—2014年6月收治的符合条件的96例重度子痫前期孕妇分为干预组及对照组，通过对入院第2日夜间血压谷值血压平均值及早晨峰值血压平均值进行对比，发现干预组夜间血压谷值血压平均值及早晨峰值血压平均值均显著低于对照组，且控制在目标血压范围内，现报告如下。
文摘There is considerable variation in the expression of severe preeclampsia. Our purpose was to determine if this is associated with maternal race or ethnicity. Study design: Individual chart review was performed for women diagnosed with severe preeclampsia at a tertiary care center from 1993 to 2003. Demographic, clinical, and lab findings from diagnosis (Dx) to 6 weeks’ postpartum (PP) were documented. Data were compared between Caucasian, African American, and Hispanic women. Data were presented for the total cohort if no significant difference was found. Results: We evaluated 473 pregnancies: 201 (Caucasian), 216 (African American), and 56 (Hispanic). Groups had similar baseline characteristics: chronic hypertension (HTN), diabetes, and initial antenatal blood pressure (mean BP 118/68). Caucasian women were older (27 vs 24 yrs), more likely nulliparous (63 vs 49% ), and had more multiple gestations (9 vs 1.5% ), P < .002 for each. African Americans had less epigastric pain (7.4 vs 10% ) and nausea (2.3 vs 5% ), P < .05 for each. Platelets < 100,000/μ L and asparate aminotransferase >60 mg/dL were more common in Caucasian women at Dx (9 vs 12% , 11 vs 21% ) and at delivery (14 vs 24% , 19 vs 34% ), P < .05 for each. No difference in severe proteinuria was seen. African Americans had more severe HTN at both Dx (44.9 vs 30% ) and peak BP (85 vs 67% ), and required more antihypertensive Rx intrapartum (12 vs 6% ), PP (38 vs 12% ), and at discharge (35 vs 21% ), P < .03 for each. Hispanics presented later (36 vs 34.6 weeks) and had less severe HTN (27 vs 40% ), P < .04 for each. BP on DC was not different between groups. Caucasian women had more hemolysis, elevated liver enzymes and low platelets syndrome (29 vs 19% , P = .01). Eclampsia, intrauterine fetal demise, intrauterine growth restriction, abruption, PP preeclampsia, and recurrent preeclampsia were similar between groups. Conclusion: African American women with severe preeclampsia demonstrate more severe hypertension and required more antihypertensive Rx, while Caucasian women have more frequent hemolysis, elevated liver enzymes and low platelets syndrome.
