We tested the hypothesis that enhanced intravascular coagulation in pregnancy could produce clinical symptoms similar to those of preeclampsia, such as hypertension, proteinuria, and edema. Having confirmed this, we then examined whether the pathological changes caused by intravascular coagulation could be suppressed by administration of antithrombin III (AT III), an endogenous inhibitor active to thrombin and factor X a. Intravascular coagulation was induced in Wistar rats on day 16-20 of pregnancy by 1-h arterial infusion of tissue thromboplastin (TP) through the left ventricle of the heart. One hour after the end of the infusion period, organ blood flows were measured by the radioactive ((57)Co-labeled) microsphere method, and fibrin deposition in organs was measured by radiolabeling with [(125)I] fibrinogen injected before TP infusion. Infusion of TP produced fibrin deposition in the kidney, lung, and liver, but not in the myometrium and placenta, as well as an 80% decrease in renal blood flow (RBF), with oliguria and proteinuria. TP also caused an increase in blood pressure (BP) accompanied by an increase in plasma renin activity (PRA), both of which were suppressed by bilateral nephrectomy before TP infusion. The prophylactic administration of AT III concentrates (60 or 300 U/kg intravenously (i.v.), followed by infusion of 30 or 150 U/kg/2 h, respectively) prevented all pathological changes in a dose-dependent manner. AT III increased placental blood flow regardless of the state of coagulation. These findings suggest that intravascular coagulation plays a significant part in the pathophysiology of preeclampsia and that AT III concentrates may have therapeutic potential in the treatment of this condition.

译文

我们检验了以下假设: 妊娠期血管内凝血增强可产生与先兆子痫相似的临床症状,例如高血压,蛋白尿和水肿。证实了这一点,我们随后检查了抗凝血酶III (AT III) 是否可以抑制由血管内凝血引起的病理变化,在怀孕的第16-20天,通过心脏左心室1小时动脉输注组织凝血活酶 (TP),在Wistar大鼠中诱导了对凝血酶和因子X a有活性的内源性抑制剂。输注期结束后1小时,通过放射性 ((57) 共标记) 微球法测量器官血流量,并通过在TP输注前注射 [(125)I] 纤维蛋白原的放射性标记来测量器官中的纤维蛋白沉积。TP的输注在肾脏,肺和肝脏中产生纤维蛋白沉积,但在子宫肌层和胎盘中不产生纤维蛋白沉积,以及少尿和蛋白尿引起的肾血流量 (RBF) 80% 减少。TP还引起血压 (BP) 升高,并伴有血浆肾素活性 (PRA) 升高,这两者均在TP输注前被双侧肾切除术抑制。预防性施用AT III浓缩物 (静脉内) 60或300 U/kg,随后分别输注30或150 U/kg/2 h) 以剂量依赖性方式防止了所有病理变化。AT III不管凝血状态如何,胎盘血流量都会增加。这些发现表明,血管内凝血在先兆子痫的病理生理中起着重要作用,而AT III浓缩物可能在治疗这种疾病方面具有治疗潜力。

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