2024, Número 2
<< Anterior Siguiente >>
Arch Med Urg Mex 2024; 16 (2)
Fisiopatología de la preeclampsia materna
Cruz-Martínez FJ
Idioma: Español
Referencias bibliográficas: 50
Paginas: 109-116
Archivo PDF: 507.49 Kb.
RESUMEN
Una vez que se da la primera etapa de la preeclampsia de aparición temprana denominada como preeclampsia placentaria, se inyectan a la
circulación sistémica micropartículas del sincitiotrofoblasto que producen el síndrome materno de preeclampsia que consiste en hipertensión
arterial, proteinuria, síndrome de fuga capilar y tendencia a la trombosis microangiopática. Mecanismos que interactúan entre sí para producir
falla orgánica que desemboca en la muerte si no se interrumpe el embarazo. En el artículo se explicará la fisiopatología de cada uno de estos
componentes describiendo mecanismos de desequilibrio en la mecánica vascular, trastornos en la dinámica de fluidos, glomeruloendoteliosis y procoagulabilidad.
REFERENCIAS (EN ESTE ARTÍCULO)
Cruz-Martínez FJ. Fisiopatología de la preeclamsia placentaria.Arch Med Urgen Mex. 2024;16(1):37-44.
Goulopoulou S, Davidge ST. Molecular mechanisms of maternalvascular dysfunction in preeclampsia. Trends Mol Med. 2015Feb;21(2):88-97.
Kappers MH, van Esch JHM, Sleijfer S, Danser AHJ, van den MeirackerAH. Cardiovascular and renal toxicity during angiogenesisinhibition: clinical and mechanistic aspects. J Hypertens 2009;27:2297–2309.
Facemire CS, Nixon AB, Griffiths R, Hurwitz H, Coffman TM. Vascularendothelial growth factor receptor 2 controls blood pressure byregulating nitric oxide synthase expression. Hypertension 2009;
54: 652–658.5. Hood JD, Meininger CJ, Ziche M, Granger HJ. VEGF upregulatesecNOS message, protein, and NO production in human endotelialcells. Am J Physiol 1998; 274: H1054–H1058.
Shen BQ, Lee DY, Zioncheck TF. Vascular endothelial growth factorgoverns endothelial nitric-oxide synthase expression via a KDR/Flk-1 receptor and a protein kinase C signaling pathway. J BiolChem 1999; 274:33057–33063.
Bouloumie A, Schini-Kerth VB, Busse R. Vascular endothelial growthfactor up-regulates nitric oxide synthase expression in endotelialcells. Cardiovasc Res 1999; 41:773–780.
Dimmeler S, Fleming I, Fisslthaler B, Hermann C, Busse R, ZeiherAM. Activation of nitric oxide synthase in endothelial cells byAkt-dependent phosphorylation. Nature 1999; 399:601–605.
Goodman R.P., Killam A.R., Brash A.R. Prostacyclin productionduring pregnancy: comparison of production during normal pregnancyand pregnancy complicated by hypertension. Am. J. Obste.Gynec 1982; 142(7): 817-822.
Chattopadhyay AB, Sharma RC, Sharma RK, et al. Altered interactionsof bioactive factors in pre-eclampsia. International Journal ofMedical and Clinical Research 2013; 4(1): 248-251.
Walsh SW. Eicosanoids in preeclampsia. Prostaglandins LeukotEssent Fatty Acids. 2004; 70: 223-232.
Itami-Sordo ME, Jiménez NR, Haro R. Factores vasculares implicadosen la Preeclampsia. Revista de la Facultad de Medicina dela UNAM 2012; 56(2): 18-24.
Khimji AK, Rockey DC. Endothelin: biology and disease. Cell Signal2010; 22: 1615–1625.
Kamoi K, Sudo N, Ishibashi M, Yamaji T. Plasma endothelin-1 levelsin patients with pregnancy-induced hypertension. N Engl JMed 1990; 323: 1486–1487.
Bernardi F, Constantino L, Machado R, Petronilho F, Dal-Pizzol F.Plasma nitric oxide, endothelin-1, arginase and superoxide dismutasein preeclamptic women. J Obstet Gynaecol Res 2008; 34:957–963.
Baksu B, Davas I, Baksu A, Akyol A, Gulbaba G. Plasma nitricoxide, endothelin-1 and urinary nitric oxide and cyclic guanosinemonophosphate levels in hypertensive pregnant women. Int J GynaecolObstet 2005; 90: 112–117.
Nova A, Sibai BM, Barton JR, Mercer BM, Mitchell MD. Maternalplasma level of endothelin is increased in preeclampsia. Am JObstet Gynecol 1991; 165: 724–727.
Jha V, Aggarwal PK, Chandel N, Jain V. Angiogenic balance anddiagnosis of preeclampsia: selecting the right VEGF receptor. JHum Hypertens 2012; 26: 205–206.
Kappers MH, van Esch JHM, Sluiter W, Sleijfer S, Danser AHJ, vanden Meiracker AH. Hypertension induced by the tyrosine kinaseinhibitor sunitinib is associated with increased circulating endothelin-1 levels. Hypertension 2010; 56: 675–681.
Kappers MH, Smedts FM, Horn T, van Esch JHM, Sleijfer S, LeijtenF, et al. The vascular endothelial growth factor receptor inhibitorsunitinib causes a preeclampsia-like syndrome with activation ofthe endothelin system. Hypertension 2011; 58:295–302.
Sakurai T, Yanagisawa M, Takuwa Y, Miyazaki H, Kimura S, Goto K,Masaki T. Cloning of a cDNA encoding a nonisopeptide-selectivesubtype of the endothelin receptor. Nature 1990; 348: 732–735.
Smarason AK, Sargent IL, Starkey PM, Redman CW. The effect ofplacental syncytiotrophoblast microvillous membranes from normaland pre-eclamptic women on the growth of endotelial cells invitro. Br J Obstet Gynaecol 1993; 100: 943–949.
Germain SJ, Sacks GP, Soorana SR, Sargent IL, Redman CW.Systemic inflammatory priming in normal pregnancy and preeclampsia:the role of circulating syncytiotrophoblast microparticles.J Immunol 2007; 178: 5949–5956.
Sabapatha A, Gercel-Taylor C, Taylor DD. Specific isolation of placenta-derived exosomes from the circulation of pregnant womenand their immunoregulatory consequences. Am J Reprod Immunol2006; 56: 345–355.
Nadeau-Vallée M, Obari D, Palacios J, et al. Sterile inflammationand pregnancy complications: a review. Reproduction. 2016 Dec;152(6):R277-R292. DOI: 10.1530/REP-16-0453.
Schaefer L. Complexity of danger: the diverse nature of damage-associated molecular patterns. J Biol Chem. 2014 Dec19;289(51):35237-45. doi: 10.1074/jbc.R114.619304.
Echeverri NP, Mockus IS. Factor nuclear kB (NF-kB): Signalosomay su importancia en enfermedades inflamatorias y cáncer. Rev.Fac. Med 2008; 56 (2): 135.
Galvis-Ramírez MF, Quintana-Castillo JC, Bueno-Sanchez JC.Novel Insights Into the Role of Glycans in the Pathophysiologyof Glomerular Endotheliosis in Preeclampsia. Front Physiol. 2018Oct 23;9:1470.
Frati-Munari AC. Importancia médica del glucocáliz endotelial [Medicalsignificance of endothelial glycocalyx]. Arch Cardiol Mex.2013 Oct-Dec;83(4):303-12.
Lee WL, Slutsky AS. Sepsis and endothelial permeability. N Engl JMed. 2010 Aug 12;363(7):689-91.
Moghaddas Sani H, Zununi Vahed S, Ardalan M. Preeclampsia:A close look at renal dysfunction. Biomed Pharmacother. 2019Jan;109:408-416.
Kazma JM, van den Anker J, Allegaert K, Dallmann A, AhmadziaHK. Anatomical and physiological alterations of pregnancy. JPharmacokinet Pharmacodyn. 2020 Aug;47(4):271-285.
Meier J, Henes J, Rosenberger P. Bleeding and coagulopathies incritical care. N Engl J Med. 2014 May 29;370(22):2152-3.
Ahn H, Park J, Gilman-Sachs A, Kwak-Kim J. Immunologic characteristicsof preeclampsia, a comprehensive review. Am JReprod Immunol. 2011 Apr;65(4):377-94. doi: 10.1111/j.1600-0897.2010.00913.x.
Gardikioti A, Venou TM, Gavriilaki E, Vetsiou E, Mavrikou I, DinasK, Daniilidis A, Vlachaki E. Molecular Advances in Preeclampsiaand HELLP Syndrome. Int J Mol Sci. 2022 Mar 31;23(7):3851.
Petca A, Miron BC, Pacu I, Dumitrașcu MC, Mehedințu C, ȘandruF, Petca RC, Rotar IC. HELLP Syndrome-Holistic Insight into Pathophysiology.Medicina (Kaunas). 2022 Feb 21;58(2):326.
Brady CW. Liver Disease in Pregnancy: What›s New. Hepatol Commun.2020 Jan 6;4(2):145-156.
Hotamisligil GS. Inflammation and metabolic disorders. Nature.2006 Dec 14;444(7121):860-7.
Buqué X, Aspichueta P, Ochoa B. Fundamento molecular de laesteatosis hepática asociada a la obesidad [Molecular basis ofobesity-related hepatic steatosis]. Rev Esp Enferm Dig. 2008Sep;100(9):565-78.
Johnson AC, Cipolla MJ. The cerebral circulation during pregnancy:adapting to preserve normalcy. Physiology (Bethesda). 2015Mar;30(2):139-47.
Johnson AC, Nagle KJ, Tremble SM, Cipolla MJ. The Contributionof Normal Pregnancy to Eclampsia. PLoS One. 2015 Jul28;10(7):e0133953.
Cipolla MJ. Cerebrovascular function in pregnancy and eclampsia.Hypertension. 2007 Jul;50(1):14-24.
Hammer ES, Cipolla MJ. Cerebrovascular Dysfunction in PreeclampticPregnancies. Curr Hypertens Rep. 2015 Aug;17(8):64.
Lacunza RO, Pacheco-Romero J. Implicancias neurológicas de lapreeclampsia, más que solo eclampsia. Revista Peruana de Ginecologíay Obstetricia. 2015 Oct;61(4):407-416.
Vezzani A, Friedman A, Dingledine RJ. The role of inflammation inepileptogenesis. Neuropharmacology. 2013 Jun;69:16-24.
Meng F, Yao L. The role of inflammation in epileptogenesis. ActaEpileptologica, 2020;2(1):1-19.
Redman CWG, Staff AC, Roberts JM. Syncytiotrophoblast stress inpreeclampsia: the convergence point for multiple pathways. Am JObstet Gynecol. 2022 Feb;226(2S):S907-S927.
Carty DM, Delles C, Dominiczak AF. Novel biomarkers for predictingpreeclampsia. Trends Cardiovasc Med. 2008;18:186–194.
Gonen R, Shahar R, Grimpel YI, et al. Placental protein 13 as anearly marker for preeclampsia: a prospective longitudinal study.BJOG. 2008;115:1465–1472.
Spencer K, Cowans NJ, Chefetz I, et al. Second-trimester uterineartery Doppler pulsatility index and maternal serum PP13 as markersof preeclampsia. Prenat Diagn. 2007;27:258–263.