先兆子痫妊娠期间和之后的母体微血管功能障碍

IF 4.2 2区 医学 Q1 PHYSIOLOGY Comprehensive Physiology Pub Date : 2024-10-09 DOI:10.1002/cphy.c240003
Kelsey S Schwartz, Anna E Stanhewicz
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引用次数: 0

摘要

先兆子痫是一种以新生高血压和母体多系统器官功能障碍为特征的妊娠疾病,是导致全球孕产妇死亡的主要原因,而且在人的一生中罹患心血管疾病的风险要高出四倍。目前对子痫前期病因的认识仍不清楚,部分原因是这种疾病的表型表现各不相同,这阻碍了在受影响的妊娠期间和之后制定有效的、针对具体机制的治疗或预防策略。子痫前期的这些孕产妇后遗症是孕产妇非生殖性微血管床系统性血管功能障碍的症状,它推动了子痫前期不良心血管后果的发生和发展。尽管分娩后血管紊乱恢复正常,但非生殖性微血管床的亚临床功能障碍依然存在,导致终生罹患心血管和代谢性疾病以及全因死亡率的风险增加。鉴于有子痫前期病史的妇女尽管没有传统的心血管疾病风险因素,但仍会表现出血管功能障碍,因此了解子痫前期和子痫后期微血管功能障碍的基本机制对于确定潜在的治疗途径以减轻或逆转明显疾病的发展至关重要。本文旨在总结有关子痫前期母体微血管功能障碍的病理生理学、分娩后残留功能障碍的内在机制、妊娠期间和妊娠后可减轻这些高危妇女微血管功能障碍的现有和潜在治疗方法的现有文献。© 2024 美国生理学会。Compr Physiol 14:5703-5727, 2024.
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Maternal Microvascular Dysfunction During and After Preeclamptic Pregnancy.

Preeclampsia, a pregnancy disorder characterized by de novo hypertension and maternal multisystem organ dysfunction, is the leading cause of maternal mortality worldwide and is associated with a fourfold greater risk of cardiovascular disease throughout the lifespan. Current understanding of the etiology of preeclampsia remains unclear, due in part to the varying phenotypical presentations of the disease, which has hindered the development of effective and mechanism-specific treatment or prevention strategies both during and after the affected pregnancy. These maternal sequelae of preeclampsia are symptoms of systemic vascular dysfunction in the maternal nonreproductive microvascular beds that drives the development and progression of adverse cardiovascular outcomes during preeclampsia. Despite normalization of vascular disturbances after delivery, subclinical dysfunction persists in the nonreproductive microvascular beds, contributing to an increased lifetime risk of cardiovascular and metabolic diseases and all-cause mortality. Given that women with a history of preeclampsia demonstrate vascular dysfunction despite an absence of traditional CVD risk factors, an understanding of the underlying mechanisms of microvascular dysfunction during and after preeclampsia is essential to identify potential therapeutic avenues to mitigate or reverse the development of overt disease. This article aims to provide a summary of the existing literature on the pathophysiology of maternal microvascular dysfunction during preeclampsia, the mechanisms underlying the residual dysfunction that remains after delivery, and current and potential treatments both during and after the affected pregnancy that may reduce microvascular dysfunction in these high-risk women. © 2024 American Physiological Society. Compr Physiol 14:5703-5727, 2024.

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来源期刊
CiteScore
10.50
自引率
0.00%
发文量
38
审稿时长
6-12 weeks
期刊介绍: Comprehensive Physiology is the most authoritative and comprehensive collection of physiology information ever assembled, and uses the most powerful features of review journals and electronic reference works to cover the latest key developments in the field, through the most authoritative articles on the subjects covered. This makes Comprehensive Physiology a valued reference work on the evolving science of physiology for both researchers and clinicians. It also provides a useful teaching tool for instructors and an informative resource for medical students and other students in the life and health sciences.
期刊最新文献
Maternal Microvascular Dysfunction During and After Preeclamptic Pregnancy. Mitochondrial Function and Dysfunction in White Adipocytes and Therapeutic Implications. Neuromuscular Transmission in a Biological Context. Function and Regulation of Bone Marrow Adipose Tissue in Health and Disease: State of the Field and Clinical Considerations. Human Gut Microbiota in Cardiovascular Disease.
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