{"id":1164,"date":"2017-04-07T21:58:34","date_gmt":"2017-04-07T19:58:34","guid":{"rendered":"http:\/\/www.newslab.sk\/2017\/04\/07\/choroba-len-pre-tehotne-preeklampsia\/"},"modified":"2017-10-03T07:52:14","modified_gmt":"2017-10-03T05:52:14","slug":"a-disease-only-for-the-pregnant-preeclampsia","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/a-disease-only-for-the-pregnant-preeclampsia\/","title":{"rendered":"A Disease only for the Pregnant \u2013 PREECLAMPSIA"},"content":{"rendered":"<pre><strong><span style=\"color: #ff0000;\">*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf\u00a0\r\nattachment at the end of the paper.\r\n\r\n<\/span><\/strong><\/pre>\n<p><strong>\u00davod<\/strong><\/p>\n<p>Objav extracelul\u00e1rnej fet\u00e1lnej DNA (cffDNA) sp\u00f4sobil revol\u00faciu v oblasti neinvaz\u00edvnej prenat\u00e1lnej diagnostiky a otvoril nov\u00e9 mo\u017enosti v oblasti p\u00f4rodn\u00edckeho v\u00fdskumu. \u00a0Zv\u00fd\u0161en\u00e9 koncentr\u00e1cie fet\u00e1lnej DNA s\u00fa \u00fazko spojen\u00e9 s r\u00f4znymi patol\u00f3- giami v tehotenstve, pri\u010dom najz\u00e1va\u017enej\u0161ie s\u00fa preeklampsia a triz\u00f3mia \u00a021. chromoz\u00f3mu(1).<\/p>\n<p>Nov\u0161ie \u00a0\u0161t\u00fadie nazna\u010dili, \u017ee hlavn\u00fdm \u00a0zdrojom cffDNA s\u00fa bunky trofoblastu, ktor\u00e9 \u00a0s\u00fa uvo\u013enen\u00e9 \u00a0zo syncyciotrofoblastu vo forme \u00a0syncyci\u00e1lnych uzlov. Tieto bunky podliehaj\u00fa apopt\u00f3ze a nukleov\u00e9 \u00a0kyseliny nach\u00e1dzaj\u00face sa vn\u00fatri vr\u00e1tane RNA a DNA s\u00fa uvo\u013enen\u00e9 do matkinho obehu. Okrem apoptick\u00fdch mechanizmov, ktor\u00e9 prebiehaj\u00fa v d\u00f4sledku norm\u00e1lneho starnutia syncyciotrofoblastu, n\u00e1hodn\u00e9 po\u0161kodenie alebo nekr\u00f3za m\u00f4\u017eu by\u0165 tie\u017e jednou z pr\u00ed\u010din uvo\u013e\u0148ovania mimobunkov\u00fdch nukleov\u00fdch \u00a0kysel\u00edn(2).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Preeklampsia<\/strong><\/p>\n<p>Preeklampsia je definovan\u00e1 ako \u00a0nov\u00fd n\u00e1stup hypertenzie a protein\u00farie v druhej\u00a0 polovici tehotenstva u predt\u00fdm zdrav\u00fdch \u017eien. \u00a0Gesta\u010dn\u00e1 \u00a0hypertenzia je \u00a0diagnostikovan\u00e1 v pr\u00edpade, \u00a0ak je systolick\u00fd krvn\u00fd tlak \u2265 140 \u00a0mmHg \u00a0a\/alebo diastolick\u00fd krvn\u00fd tlak \u2265 90 mmHg aspo\u0148 vo dvoch \u00a0po sebe nasleduj\u00facich meraniach v priebehu 4-6 hod\u00edn. Protein\u00faria je definovan\u00e1, ak je u tehotnej \u017eeny zaznamenan\u00e1 pr\u00edtomnos\u0165 \u2265 300 mg prote\u00ednov v mo\u010di zbieranom 24 hod\u00edn. \u0164a\u017ek\u00e1 preeklampsia sa vyzna\u010duje hypertenziou so systolick\u00fdm krvn\u00fdm tlakom minim\u00e1lne 160 mmHg a\/alebo s diastolick\u00fdm krvn\u00fdm tlakom \u00a0najmenej 110 mmHg \u00a0alebo \u00a0protein\u00fariou s vylu\u010dovan\u00edm aspo\u0148 1 g prote\u00ednov po\u010das 24 hod\u00edn(3). \u00a0Av\u0161ak hypertenzia alebo \u00a0protein\u00faria nie s\u00fa pr\u00edtomn\u00e9 u 10 \u2013 15 % \u017eien, u kto- r\u00fdch sa vyv\u00edja HELLP syndr\u00f3m (hemol\u00fdza, zv\u00fd\u0161en\u00e9 hodnoty pe\u010de\u0148ov\u00fdch enz\u00fdmov \u00a0a n\u00edzky po\u010det krvn\u00fdch do\u0161ti\u010diek)(4). Hoci u\u017e existuj\u00fa \u00a0smernice pre skr\u00edning \u00a0a v\u010dasn\u00fa detekciu tohto ochorenia, \u017eia\u013e, neexistuje jeden univerz\u00e1lny skor\u00fd marker preeklampsie.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Rizikov\u00e9 <\/strong><strong>faktory<\/strong><\/p>\n<p>Vzh\u013eadom \u00a0na \u00a0to, \u017ee \u00a0etiopatogen\u00e9za preeklampsie st\u00e1le zost\u00e1va nezn\u00e1ma, je \u0165a\u017ek\u00e9 n\u00e1js\u0165 prevl\u00e1daj\u00face znaky \u00a0medzi tehotn\u00fdmi \u017eenami postihnut\u00fdmi t\u00fdmto \u00a0ochoren\u00edm, preto\u017ee pr\u00edznaky medzi jednotliv\u00fdmi \u017eenami sa v\u00fdrazne l\u00ed\u0161ia. Je v\u0161ak zn\u00e1mych nieko\u013eko rizikov\u00fdch faktorov. \u00a0Preeklampsia v predch\u00e1dzaj\u00facom tehotenstve je v\u00fdznamn\u00fdm rizikov\u00fdm faktorom v ka\u017edom \u010fal\u0161om tehotenstve u danej \u00a0\u017eeny(5).\u00a0 Op\u00e4tovn\u00fd \u00a0v\u00fdskyt preeklampsie je asi \u00a014 %, okrem \u00a0toho \u00a0je a\u017e 7-n\u00e1sobne vy\u0161\u0161ie riziko vzniku preeklampsie u \u017eien, u ktor\u00fdch \u00a0sa toto ochorenie u\u017e vyskytlo, v porovnan\u00ed so \u017eenami, \u00a0ktor\u00e9 predt\u00fdm\u00a0preeklampsiu nemali. \u017deny, u ktor\u00fdch sa v predch\u00e1dzaj\u00facom tehotenstve vyskytla \u00a0\u0165a\u017ek\u00e1 \u00a0forma \u00a0preeklampsie, s\u00fa rizikovou skupinou \u017eien, ktor\u00e9 by mali by\u0165 pod pr\u00edsnym \u00a0lek\u00e1rskym doh\u013eadom u\u017e \u00a0na za\u010diatku ka\u017ed\u00e9ho \u010fal\u0161ieho tehotenstva. U \u017eien, ktor\u00e9 trpia chronickou hypertenziou, je frekvencia v\u00fdskytu \u00a0ochorenia vy\u0161\u0161ie \u00a0a\u017e o 25 %, u \u017eien, ktor\u00e9 \u00a0maj\u00fa \u00a0diabetes \u00a0mellitus, je to 22 % a 14 % u \u017eien, u ktor\u00fdch sa preeklampsia \u00a0vyskytla v predch\u00e1dzaj\u00facom tehotenstve(5). Pri druhom tehotenstve s\u00fa u \u017eien v\u00fdznamn\u00fdmi rizikov\u00fdmi faktormi: \u00a0dlh\u0161\u00ed \u00a0interval \u00a0medzi \u00a0jednotliv\u00fdmi \u00a0p\u00f4rodmi, \u00a0pred\u010dasn\u00fd p\u00f4rod v predch\u00e1dzaj\u00facom tehotenstve, a teda \u00a0n\u00edzky gesta\u010dn\u00fd vek novorodenca v predch\u00e1dzaj\u00facom tehotenstve, obli\u010dkov\u00e9 ochorenie, chronick\u00e1 hypertenzia, diabetes mellitus, obezita, nedostato\u010dn\u00e1 prenat\u00e1lna starostlivos\u0165 a in\u00e9(6). Rizikovou skupinou s\u00fa aj prvorodi\u010dky, u ktor\u00fdch je a\u017e 26 % riziko v\u00fdskytu preeklampsie oproti \u017een\u00e1m, ktor\u00e9 rodili u\u017e viackr\u00e1t.<\/p>\n<p>Obezita je tie\u017e definovan\u00e1 ako riziko pre preeklampsiu, ktor\u00e9 rastie so \u00a0zv\u00fd\u0161en\u00edm indexu telesnej hmotnosti (BMI &gt; 30) v porovnan\u00ed so \u00a0\u017eenami s norm\u00e1lnou hmotnos\u0165ou(7). Niektor\u00e9 \u0161t\u00fadie uv\u00e1dzaj\u00fa s\u00favislos\u0165 medzi \u00a0vekom a preeklampsiou, a to najm\u00e4 u \u017eien vo veku 40 rokov. Tieto \u017eeny mali takmer\u00a02-n\u00e1sobn\u00e9 riziko vzniku preeklampsie v porovnan\u00ed s mlad\u0161\u00edmi \u017eenami(5). K vy\u0161\u0161iemu veku\u00a0 matky \u00a0sa via\u017ee \u00a0\u010fal\u0161\u00ed \u00a0rizikov\u00fd faktor, a to dlh\u0161\u00ed interval \u00a0medzi \u00a0jednotliv\u00fdmi \u00a0tehotenstvami. Ak je interval medzi \u00a0dvomi tehotenstvami 10 a viac rokov, vedie to k vy\u0161\u0161iemu riziku preeklampsie. Rovnako tak aj tehotenstv\u00e1 nes\u00face mu\u017esk\u00fd \u00a0plod sa zdaj\u00fa spojen\u00e9 s preeklampsiou, \u010do by mohlo by\u0165 v d\u00f4sledku zv\u00fd\u0161enej hladiny testoster\u00f3nu(8).<\/p>\n<p>Predch\u00e1dzaj\u00faci potrat alebo \u00a0zdrav\u00e9 \u00a0tehotenstvo s rovnak\u00fdm partnerom s\u00fa, naopak, spojen\u00e9 so zn\u00ed\u017een\u00fdm rizikom preeklampsie, aj ke\u010f tento \u00a0ochrann\u00fd \u00fa\u010dinok \u00a0sa str\u00e1ca so zmenou partnera(9). Napriek \u00a0mno\u017estvu nepriazniv\u00fdch \u00fa\u010dinkov \u00a0faj\u010denia, \u00a0vr\u00e1tane obmedzenia rastu plodu, pred\u010dasn\u00e9ho p\u00f4rodu, narodenia m\u0155tveho plodu a abrupcie placenty, 12 \u2013 15 % v\u0161etk\u00fdch tehotn\u00fdch \u017eien po\u010das tehotenstva faj\u010d\u00ed. Paradoxne, mnoho \u0161t\u00fadi\u00ed prin\u00e1\u0161a inform\u00e1ciu, \u017ee faj\u010denie je spojen\u00e9 so zn\u00ed\u017een\u00fdm rizikom preeklampsie. Na druhej strane je tu mo\u017enos\u0165, \u017ee faj\u010denie m\u00f4\u017ee \u00a0vies\u0165 k pred\u010dasn\u00e9mu p\u00f4rodu, \u00a0a tak m\u00f4\u017ee zni\u017eova\u0165 v\u00fdskyt preeklampsie. Tak\u017ee faj\u010denie po\u010das tehotenstva m\u00f4\u017ee by\u0165 nepriamo spojen\u00e9 s rizikom preeklampsie(10).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>P<\/strong><strong>atogen\u00e9za <\/strong><strong>pr<\/strong><strong>eeklampsie<\/strong><\/p>\n<p>Vysok\u00fd v\u00fdskyt preeklampsie u prvorodi\u010diek odr\u00e1\u017ea \u201enesk\u00fasen\u00fa\u201c imunitn\u00fa \u00a0odpove\u010f matky na \u00a0tehotenstvo. Be\u017en\u00e9 rizikov\u00e9 faktory \u00a0preeklampsie zah\u0155\u0148aj\u00fa chronick\u00fa hypertenziu, diabetes, vek matky, obezitu, \u00a0predch\u00e1dzaj\u00facu preeklampsiu, trombof\u00edliu, \u00a0autoimunitn\u00e9 ochorenie, vaskul\u00e1rne ochorenie \u00a0a in\u00e9. Predch\u00e1dzaj\u00face rizikov\u00e9 faktory \u00a0hraj\u00fa \u00a0d\u00f4le\u017eit\u00fa \u00falohu pri zmene citlivosti \u00a0vo\u010di adapta\u010dn\u00fdm zmen\u00e1m podie\u013eaj\u00facim sa na tehotenstve, a t\u00fdm zvy\u0161uj\u00fa n\u00e1chylnos\u0165 na preeklampsiu. Patogen\u00e9za \u00a0preeklampsie zatia\u013e \u00a0nie je celkom objasnen\u00e1 pre\u00a0 svoju \u00a0heterog\u00e9nnu multisyst\u00e9mov\u00fa povahu. Boli navrhnut\u00e9 r\u00f4zne \u00a0te\u00f3rie, aby vysvetlili patogen\u00e9zu preeklamspie, ktor\u00e1 \u00a0zah\u0155\u0148a genetick\u00fa predispoz\u00edciu, dysfunkciu regul\u00e1cie imunitn\u00e9ho syst\u00e9mu, placent\u00e1rnu isch\u00e9miu, z\u00e1pal a \u010fal\u0161ie. Av\u0161ak s\u013eubn\u00fdm vysvetlen\u00edm patogen\u00e9zy je zlyhanie fyziologickej \u00a0transform\u00e1cie \u0161pir\u00e1lnej art\u00e9rie \u00a0a nedostato\u010dn\u00e1 inv\u00e1zia trofoblastu(11) <strong><em>(obr\u00e1zok \u00a01)<\/em><\/strong>. Po\u010das norm\u00e1lneho tehotenstva vyv\u00edjaj\u00faci sa plod prij\u00edma v\u00fd\u017eivu a z\u00e1sobu kysl\u00edka cez \u00a0\u0161pir\u00e1lne art\u00e9rie \u00a0maternice. Aby sa prisp\u00f4sobili zv\u00fd\u0161enej potrebe kysl\u00edka a v\u00fd\u017eivy, art\u00e9rie \u00a0podst\u00fapia vaskul\u00e1rnu remodel\u00e1ciu. Proces vaskul\u00e1rnej remodel\u00e1cie sa za\u010d\u00edna v prvom trimestri a kon\u010d\u00ed sa v 18. \u2013 20. t\u00fd\u017edni tehotenstva. \u00a0Cie\u013eom remodel\u00e1cie je zmeni\u0165 \u0161pir\u00e1lne art\u00e9rie \u00a0maternice z vysokorezistentn\u00fdch, n\u00edzkokapacitn\u00fdch krvn\u00fdch ciev na n\u00edzkorezistentn\u00e9, \u00a0vysokokapacitn\u00e9 cievy. Vaskul\u00e1rna remodel\u00e1cia trv\u00e1\u00a08 \u2013 12 t\u00fd\u017ed\u0148ov \u00a0tehotenstva, po\u010das ktor\u00fdch \u00a0extravilov\u00e9 bunky trofoblastu nap\u00e1daj\u00fa decidu\u00e1lnu \u010das\u0165 \u0161pir\u00e1lnych art\u00e9ri\u00ed(12). Predpoklad\u00e1 sa, \u00a0\u017ee pri preeklampsii je obmedzen\u00e1 inv\u00e1zia trofoblastu, \u010d\u00edm \u00a0sa zabr\u00e1ni \u00a0spr\u00e1vnej \u00a0transform\u00e1cii \u0161pir\u00e1lnych\u00a0 art\u00e9ri\u00ed, a teda \u00a0nedoch\u00e1dza k zmene fenotypu elastick\u00e9ho \u00a0svalstva. Nedostato\u010dn\u00e1 inv\u00e1zia\u00a0 trofoblastu sp\u00f4sobuje hypoperf\u00faziu a hypoxiu v placente. Druh\u00e9 \u0161t\u00e1dium je charakterizovan\u00e9 hypoxiou a hypoperf\u00faziou sprostredkovanou syst\u00e9movou z\u00e1palovou odpove\u010fou, ktor\u00e1 uvo\u013e\u0148uje r\u00f4zne z\u00e1palov\u00e9, angiog\u00e9nne a vazoakt\u00edvne faktory do obehu. Tieto faktory ved\u00fa k materskej syst\u00e9movej endotelovej dysfunkcii, t. j. doch\u00e1dza k aktiv\u00e1cii\u00a0 koagula\u010dn\u00e9ho syst\u00e9mu, vazokonstrikcii, hemol\u00fdze, \u010do ma za n\u00e1sledok protein\u00fariu a hypertenziu, ktor\u00e9 s\u00fa charakteristick\u00fdmi klinick\u00fdmi pr\u00edznakmi preeklampsie(13).<\/p>\n<p>A tak nedostatok \u00fa\u010dinn\u00fdch \u00a0diagnostick\u00fdch a terapeutick\u00fdch lie\u010debn\u00fdch z\u00e1krokov rob\u00ed preeklampsiu ve\u013ekou v\u00fdzvou pre lek\u00e1rov. \u00a0P\u00f4rod \u00a0plodu \u00a0a z\u00e1rove\u0148 placenty tak zost\u00e1va jedinou \u00fa\u010dinnou \u00a0lie\u010dbou \u00a0na ust\u00fapenie sympt\u00f3mov preeklampsie(14).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>A<\/strong><strong>ngiog\u00e9nne <\/strong><strong>faktory<\/strong><\/p>\n<p>V patogen\u00e9ze preeklampsie si zna\u010dn\u00fa pozornos\u0165 z\u00edskali aj angiog\u00e9nne rastov\u00e9 faktory, najm\u00e4 \u00a0placent\u00e1rny rastov\u00fd \u00a0fak- tor (PlGF), vaskul\u00e1rny endotelov\u00fd rastov\u00fd \u00a0faktor (VEGF) a antiangiog\u00e9nny rozpustn\u00fd VEGF receptor 1 (solubiln\u00e1 tyroz\u00ednkin\u00e1za podobn\u00e1 fms alebo sFlt-1). Angiog\u00e9nne rastov\u00e9 faktory hraj\u00fa \u00a0pravdepodobne d\u00f4le\u017eit\u00fa \u00a0\u00falohu \u00a0vo vaskul\u00e1rnej funkcii a v remodel\u00e1cii matersk\u00e9ho cievneho syst\u00e9mu po\u010das tehotenstva vr\u00e1tane maternicovej \u0161pir\u00e1lnej art\u00e9rie \u00a0prech\u00e1dzaj\u00facej placentou. Rozpustn\u00fd Flt-1 via\u017ee \u00a0VEGF a PlGF, s\u00fa\u0165a\u017e\u00ed s nadv\u00e4zovan\u00edm receptorov, ktor\u00e9 s\u00fa umiestnen\u00e9 na endoteli, a je spojen\u00fd so zn\u00ed\u017eenou funkciou \u00a0ciev. Levine a spol. \u00a0zaznamenali v\u00fdznamn\u00e9 rozdiely v t\u00fdchto angiog\u00e9nnych faktoroch, ktor\u00e9 \u00a0predch\u00e1dzaj\u00fa klinick\u00fdm prejavom preeklampsie. Zv\u00fd\u0161en\u00e9 hladiny angiog\u00e9nnych faktorov, ako je placent\u00e1rna solubiln\u00e1 tyroz\u00ednkin\u00e1za podobn\u00e1 fms (sFlt-1) a solubiln\u00fd endoglin (sEng) s\u00fa zaznamenan\u00e9 v pr\u00edpadoch preeklampsie u\u017e v 12. t\u00fd\u017edni tehotenstva, ale slab\u00e9 predikt\u00edvne hodnoty t\u00fdchto markerov v nasleduj\u00facich \u0161t\u00fadi\u00e1ch prek\u00e1\u017eaj\u00fa ich klinick\u00e9mu pou\u017eitiu \u00a0ako predikt\u00edvne markery. \u00a0Konkr\u00e9tne \u00a0bola zazname- nan\u00e1 ni\u017e\u0161ia \u00a0koncentr\u00e1cia PlGF, zatia\u013e \u010do koncentr\u00e1cia sFlt-1 bola zv\u00fd\u0161en\u00e1. Naopak, \u00a0ned\u00e1vne d\u00f4kazy \u00a0nazna\u010duj\u00fa, \u017ee faj\u010denie cigariet \u00a0po\u010das tehotenstva m\u00f4\u017ee koncentr\u00e1ciu matern\u00e1lneho \u00a0sFlt-1 zn\u00ed\u017ei\u0165(15).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Genetick\u00e9 <\/strong><strong>mark<\/strong><strong>er<\/strong><strong>y<\/strong><\/p>\n<p>Ve\u013ek\u00e9 mno\u017estvo v\u00fdskumov \u00a0v\u0161ak \u00a0poukazuje na\u00a0 to, \u017ee na rozvoj \u00a0tohto \u00a0ochorenia m\u00e1 \u00a0vplyv multifaktori\u00e1lna polyg\u00e9nna dedi\u010dnos\u0165, \u00a0preto bolo sk\u00faman\u00fdch ve\u013ea kandid\u00e1tnych g\u00e9nov a polymorfizmov vo vz\u0165ahu \u00a0s preeklampsiou <strong><em>(obr\u00e1zok 2)<\/em><\/strong>. Z epidemiologick\u00e9ho h\u013eadiska mnoh\u00e9 \u0161t\u00fadie ukazuj\u00fa, \u017ee preeklampsia je ochorenie so silnou rodinnou predispoz\u00edciou. Bolo zisten\u00e9, \u017ee \u017eeny, ktor\u00fdch prvostup\u0148ov\u00e9 pr\u00edbuzn\u00e9 mali preeklampsiu, maj\u00fa 5-n\u00e1sobne vy\u0161\u0161ie \u00a0riziko vzniku ochorenia, zatia\u013e \u010do tie s druhostup\u0148ov\u00fdmi pr\u00edbuzn\u00fdmi \u00a0maj\u00fa len 2-n\u00e1sobn\u00e9 riziko(16). \u00a0Okrem \u00a0toho \u00a0sa predpoklad\u00e1, \u017ee otcovsk\u00e9 g\u00e9ny hraj\u00fa tie\u017e d\u00f4le\u017eit\u00fa \u00falohu\u00a0 vo v\u00fdvoji preeklampsie(17).<\/p>\n<p>Napriek \u00a0tomu \u00a0existuj\u00fa \u00a0viacer\u00e9 \u00a0celogen\u00f3mov\u00e9 asocia\u010dn\u00e9 \u0161t\u00fadie, v ktor\u00fdch \u00a0sa zatia\u013e nepodarilo preuk\u00e1za\u0165 asoci\u00e1ciu sk\u00faman\u00fdch genetick\u00fdch variantov s preeklampsiou. Av\u0161ak nov\u00e9 \u00a0modern\u00e9 technol\u00f3gie, sekvenovanie novej\u00a0 gener\u00e1cie, otv\u00e1raj\u00fa mo\u017enosti v objas\u0148ovan\u00ed genetick\u00fdch po\u0161koden\u00ed, ktor\u00e9 sp\u00f4sobuj\u00fa dedi\u010dn\u00e9 ochorenia predov\u0161etk\u00fdm v pr\u00edpadoch s nejednozna\u010dnou klinickou diferenci\u00e1lnou diagnostikou.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Z\u00e1ver<\/strong><\/p>\n<p>Preeklampsia je jedna z naj\u010dastej\u0161\u00edch a najnebezpe\u010dnej\u0161\u00edch \u00a0komplik\u00e1ci\u00ed \u00a0tehotenstva. Aj ke\u010f presn\u00e1 etiol\u00f3gia nie je e\u0161te objasnen\u00e1, predpoklad\u00e1 sa, \u017ee najv\u00e4\u010d\u0161\u00ed vplyv m\u00e1 placenta a\/alebo vaskul\u00e1rny syst\u00e9m matiek. \u00a0Preto \u00a0je extr\u00e9mne n\u00e1ro\u010dn\u00e9 objasnenie, prevencia a predikcia tohto ochorenia, preto\u017ee\u00a0 je potrebn\u00e9 vzia\u0165 do \u00favahy pr\u00edli\u0161 ve\u013ea parametrov.<\/p>\n<p>Uk\u00e1zalo sa, \u017ee zv\u00fd\u0161enie fet\u00e1lnej DNA v krvnom obehu matky v skorom \u0161t\u00e1diu tehotenstva je tie\u017e znakom rozvoja \u00a0preeklampsie. Kvantitat\u00edvne zmeny \u00a0mimobunkovej fet\u00e1lnej DNA v materskej plazme s\u00fa indik\u00e1torom pre fet\u00e1lne poruchy. Zmena \u00a0koncentr\u00e1cie fet\u00e1lnej DNA po\u010das tehotenstva m\u00f4\u017ee by\u0165 sp\u00f4soben\u00e1 v d\u00f4sledku \u00a0placent\u00e1rnej nekr\u00f3zy \u00a0alebo \u00a0apopt\u00f3zy, alebo v d\u00f4sledku zn\u00ed\u017een\u00e9ho odstra\u0148ovania DNA. Zv\u00fd\u0161en\u00e9 mno\u017estvo fet\u00e1lnej DNA m\u00f4\u017ee by\u0165 detegovan\u00e9 u\u017e v skorom \u0161t\u00e1diu tehotenstva a nesie so sebou 8-n\u00e1sobne vy\u0161\u0161ie riziko vzniku preeklampsie(18). Teda sa uk\u00e1zalo, \u017ee koncentr\u00e1cia fet\u00e1lnej DNA je v preeklampsii podstatne vy\u0161\u0161ia \u00a0ako \u00a0v norm\u00e1lnych tehotenstv\u00e1ch, a \u00a0to \u00a0e\u0161te pred \u00a0n\u00e1stupom prv\u00fdch klinick\u00fdch sympt\u00f3mov(19). Z toho \u00a0d\u00f4vodu \u00a0s\u00fa potrebn\u00e9 \u0161iroko\u00a0 pou\u017eite\u013en\u00e9 a cenovo dostupn\u00e9 testy, ktor\u00e9 umo\u017enia skor\u00e9 \u00a0diagnostikovanie e\u0161te pred v\u00fdskytom klinick\u00fdch sympt\u00f3mov. Tak\u017ee kvantifik\u00e1cia fet\u00e1lnej DNA v krvnom obehu matky v skorom \u0161t\u00e1diu tehotenstva by mohla \u00a0by\u0165 skr\u00edningov\u00fdm testom.<\/p>\n<p>Av\u0161ak preeklampsia je heterog\u00e9nne multisyst\u00e9mov\u00e9 ochorenie, preto \u00a0je tie\u017e ot\u00e1zne, \u010di hladina cffDNA m\u00f4\u017ee \u00a0by\u0165 pou\u017eit\u00e1 ako predikt\u00edvny faktor preeklampsie. A tak prich\u00e1dza ot\u00e1zka, \u010di je zv\u00fd\u0161enie hladiny cffDNA pr\u00ed\u010dinou \u00a0alebo \u00a0d\u00f4sledkom preeklampsie.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Literat\u00fara<\/strong><br \/>\n1. Lo YM. Fetal DNA in maternal plasma. Annals of the New York Academy<br \/>\nof Sciences 2000; 906: 141-147.<br \/>\n2. Litton C, Stone J, Eddleman K, et al. Noninvasive prenatal diagnosis:<br \/>\npast, present, and future. The Mount Sinai Journal of Medicine 2009; 76:<br \/>\n521-528.<br \/>\n3. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet 2005; 365:<br \/>\n785-799.<br \/>\n4. Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues<br \/>\nand management. A Review. BMC pregnancy and childbirth 2009; 9:<br \/>\n1-15.<br \/>\n5. Trogstad L, Magnus P, Stoltenberg C. Pre-eclampsia: Risk factors and<br \/>\ncausal models. Best practice and research Clinical obstetrics and gynaecology<br \/>\n2011; 25: 329-342.<br \/>\n6. Mostello D, Catlin TK, Roman L, et al. Preeclampsia in the parous<br \/>\nwoman: who is at risk?. American Journal of Obstetrics and Gynecology<br \/>\n2002; 187: 425-429.<br \/>\n7. Boghossian NS, Yeung E, Mendola P, et al. Risk factors differ between<br \/>\nrecurrent and incident preeclampsia: a hospital-based cohort study. Annals<br \/>\nof Epidemiology 2014; 24: 871-877.<br \/>\n8. Shamsi U, Saleem S, Nishter N. Epidemiology and risk factors of<br \/>\npreeclampsia; an overview of observational studies. Al Ameen Journal of<br \/>\nMedical Sciences 2013; 6: 292-300.<br \/>\n9. Saftlas AF, Levine RJ, Klebanoff MA, et al. Abortion, changed paternity,<br \/>\nand risk of preeclampsia in nulliparous women. American Journal of<br \/>\nEpidemiology 2003; 157: 1108-1114.<br \/>\n10. Kawashima A., Koide K, Ventura W, et al. Effects of maternal smoking<br \/>\non the placental expression of genes related to angiogenesis and apoptosis<br \/>\nduring the first trimester. PloS one 2014; 9: 1-7.<br \/>\n11. George EM, Granger JP. Recent insights into the pathophysiology<br \/>\nof preeclampsia. Expert Review of Obstetrics and Gynecology 2010; 5:<br \/>\n557-566.<br \/>\n12. Jadli A, Sharma N, Damania K, et al. Promising prognostic markers of<br \/>\npreeclampsia: new avenues in waiting. Thrombosis Research 2015; 136:<br \/>\n189-195.<br \/>\n13. Maynard SE, Karumanchi SA. Angiogenic factors and preeclampsia.<br \/>\nSeminars in Nephrology 2011; 31: 33-46.<br \/>\n14. Shennan AH, Redman C, Cooper C, et al. Are most maternal deaths<br \/>\nfrom preeclampsia avoidable? Lancet 2012; 379: 1686-1687.<br \/>\n15. Levine RJ, Lam C, Qian C, et al. Soluble endoglin and other circulating<br \/>\nantiangiogenic factors in preeclampsia. The New England journal of medicine<br \/>\n2006; 355: 992-1005.<br \/>\n16. Steegers EAP, von Dadelszen P, Duvekot JJ, et al. Preeclampsia. Lancet<br \/>\n2010; 376: 631-644.<br \/>\n17. Wikstr\u00f6m AK, Gunnarsd\u00f3ttir J, Cnattingius S. The paternal role in<br \/>\npre-eclampsia and giving birth to a small for gestational age infant; a population-<br \/>\nbased cohort study 2012; 2: 1-9.<br \/>\n18. Cotter AM, Martin CM, O\u2018leary JJ, et al. Increased fetal DNA in the maternal<br \/>\ncirculation in early pregnancy is associated with an increased risk<br \/>\nof preeclampsia. American Journal of Obstetrics and Gynecology 2004;<br \/>\n191: 515-520.<br \/>\n19. Engel K, Plonka T, Bilar M, et al. The correlation between clinical characteristics<br \/>\nof preeclampsia and the concentration of fetal DNA in maternal<br \/>\ncirculation. European Journal of Obstetrics, Gynecology, and Reproductive<br \/>\nBiology 2008; 139: 256-257.<br \/>\n20. Chaiworapongsa T, Chaemsaithong P, Yeo L, et al. Pre-eclampsia<br \/>\npart 1: current understanding of its pathophysiology. Nature Reviews.<br \/>\nNephrology 2014; 10: 466-480.<br \/>\n21. Jebbink J, Wolters A, Fernando F, et al. Molecular genetics of preeclampsia<br \/>\nand HELLP syndrome \u2014 A<\/p>\n","protected":false},"excerpt":{"rendered":"<p>*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf\u00a0 attachment at the end of the paper. \u00davod Objav extracelul\u00e1rnej fet\u00e1lnej DNA (cffDNA) sp\u00f4sobil revol\u00faciu v oblasti neinvaz\u00edvnej prenat\u00e1lnej diagnostiky a otvoril nov\u00e9 mo\u017enosti v oblasti p\u00f4rodn\u00edckeho v\u00fdskumu. \u00a0Zv\u00fd\u0161en\u00e9 koncentr\u00e1cie fet\u00e1lnej DNA s\u00fa \u00fazko spojen\u00e9 s r\u00f4znymi<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[298],"tags":[607,605,606,571],"class_list":["post-1164","post","type-post","status-publish","format-standard","hentry","category-molecular-biology","tag-angiogenic-factors","tag-extracellular-foetal-dna","tag-hypertension","tag-preeclampsia","typ_clanku-review-article"],"acf":{"abstrakt":"<p>Preeclampsia (PE) is a\u00a0multiple-systemic disease affecting 2 \u2013 8 % of all pregnant women that constitutes one of the major causes of maternal and foetal mortality and morbidity. Globally, PE and the related diseases annually cause death of 76 000 of pregnant women and the number of children dying because of this disease every year is very high, too. Currently, no reliable parameter exists for early diagnosis of PE, however hypertension and proteinuria after 20<sup>th<\/sup> week of pregnancy represent symptoms of disease onset. Although pathomechanism of PE continues to remain unknown, a stable hypothesis indicates the disruption of placental function at early stage of pregnancy as the cause. During pregnancy, placenta represents a close link between maternal and foetal system. The search for predictive markers in maternal blood is extremely demanding exactly because of this link, since the markers may be derived either from purely maternal or purely foetal sources or from both alike.<\/p>\n<p><strong>Key words: <\/strong>preeclampsia, extracellular foetal DNA, hypertension, angiogenic factors<\/p>\n","casopis":[{"ID":735,"post_author":"7","post_date":"2017-04-06 13:21:01","post_date_gmt":"2017-04-06 11:21:01","post_content":"<ul>\r\n \t<li>Pseudoglandular nevus \u2013 a rare morphology of melanocytic nevus (case report)<\/li>\r\n \t<li>Differential molecular diagnosis of multiple myeloma and Waldenstr\u00f6m macroglobulinemia<\/li>\r\n \t<li>Molecular analysis of prognostically significant markers of chronic lymphocytic leukemia<\/li>\r\n \t<li>Prevalence of <em>Streptococcus pneumoniae<\/em> phyla in inflammatory diseases of upper airways in preschool age children and their resistance to antibiotics<\/li>\r\n \t<li>Malign melanoma - new aspects of research<\/li>\r\n \t<li style=\"list-style-type: none;\"><\/li>\r\n<\/ul>","post_title":"Newslab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab-2017-1","to_ping":"","pinged":"","post_modified":"2017-08-16 21:11:52","post_modified_gmt":"2017-08-16 19:11:52","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.newslab.sk\/?post_type=casopis&#038;p=735\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"53","upload_clanok":{"ID":987,"id":987,"title":"Choroba len pre tehotn\u00e9 \u2013 PREEKLAMPSIA","filename":"Choroba-len-pre-tehotn\u00e9-\u2013-PREEKLAMPSIA.pdf","filesize":872901,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2017\/04\/Choroba-len-pre-tehotn\u00e9-\u2013-PREEKLAMPSIA.pdf","link":"https:\/\/www.newslab.sk\/en\/a-disease-only-for-the-pregnant-preeclampsia\/choroba-len-pre-tehotne-preeklampsia\/","alt":"","author":"7","description":"","caption":"","name":"choroba-len-pre-tehotne-preeklampsia","status":"inherit","uploaded_to":1164,"date":"2017-04-07 19:43:49","modified":"2017-04-07 19:43:49","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1164","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=1164"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1164\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1164"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1164"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1164"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}