| Abstract | Cilj istraživanja: Cilj istraživanja bio je ispitati utjecaj unosa soli hranom tijekom normalne
trudnoće na maternalnu mikrovaskularnu i makrovaskularnu reaktivnost ovisnu o endotelu, razinu
oksidativnog stresa, indekse fetoplacentne vaskularne funkcije, aktivnost renin-angiotenzinaldosteronskog sustava, ravnotežu placentnih proangiogenih i antiangiogenih čimbenika te biljege
pregradnje posteljice.
Nacrt studije: Ovo istraživanje ustrojeno je kao presječna opservacijska studija u kojoj su svim
ispitanicima uzeti podatci, uzorkovanja i izvršena mjerenja u dvije vremenske točke.
Ispitanici i metode: Na temelju 24-satne natrijureze trudnice (37 – 40 tjedana trudnoće)
podijeljene su u tri skupine: normalni unos soli (NS; < 5,75 g/dan, N = 12), velik unos soli (HS;
5,75 – 10,25 g/dan, N = 36) i vrlo velik unos soli (VHS; > 10,25 g/dan, N = 17). Svim ispitanicama
izmjerena je mikrovaskularna reaktivnost kože podlaktice u odgovoru na vaskularnu okluziju,
lokalno zagrijavanje (LTH) i iontoforezu acetilkolina (AChID), kao i protokom posredovana
dilatacija (FMD) brahijalne arterije. Izmjereni su sljedeći biljezi endotelne funkcije i oksidativnog
stresa: serumska koncentracija dušikovog oksida (NO), endokana, 8-izo-prostaglandina F2a (8-izoPGF2a), reaktivne supstance tiobarbiturne kiseline (TBARS) i sposobnost redukcije željeza u
plazmi. Izmjereni su ultrazvučni pokazatelji fetoplacentne funkcije, aktivnost renina u plazmi,
koncentracija aldosterona, topljive fms-u slične tirozin kinaze-1 (sFlt-1) i posteljičnog čimbenika
rasta (PlGF) u serumu te koncentracija vaskularnog endotelnog čimbenika rasta C (VEGF-C) i
matriks metaloproteinaze 9 (MMP-9) u tkivu posteljice.
Rezultati: FMD brahijalne arterije, mikrovaskularni AChID i LTH značajno su smanjeni u skupini
VHS u usporedbi sa skupinom NS, a i LTH u skupini NS u usporedbi sa skupinom HS. NO je bio
značajno smanjen u skupinama HS i VHS u usporedbi sa skupinom NS. Endokan, 8-izo-PGF2a i
TBARS bili su značajno povećani u skupini VHS u usporedbi sa skupinom NS. Indeks pulsatilnosti
fetalne srednje cerebralne arterije (MCA) bio je značajno smanjen u skupinama HS i VHS u
usporedbi sa skupinom NS. Koncentracija aldosterona pokazala je tendenciju porasta s unosom
soli, a omjer sFlt-1/PlGF bio je značajno smanjen u skupini VHS u usporedbi sa skupinom NS.
Koncentracija VEGF-C i MMP-9 nije se razlikovala među skupinama.
8. SAŽETAK
74
Zaključak: Velik unos soli hranom povezan je sa smanjenom vazodilatacijom ovisnom o endotelu
posredovanom NO-om u perifernoj mikrocirkulaciji i makrocirkulaciji zdravih trudnica te
povećanim oksidativnim stresom. Nadalje velik unos soli povezan je sa smanjenom pulsatilnošću
fetalne MCA, ali i povišenom koncentracijom aldosterona, smanjenim (povoljnijim) omjerom sFlt1/PlGF i nepromijenjenim biljezima pregradnje posteljice. |
| Abstract (english) | Title: The effects of salt intake on vascular function in pregnant women in the third trimester of
pregnancy
Objectives: The aim of the study was to investigate the effects of dietary salt intake during normal
pregnancy on maternal endothelium-dependent micro- and macrovascular reactivity, degree of
oxidative stress, indices of fetoplacental vascular function, activity of the renin-angiotensinaldosterone system (RAAS), balance of placental pro- and antiangiogenic factors, and biomarkers
of placental remodeling.
Study design: This study was designed as a cross-sectional observational study in which data,
samples and measurements were taken from all respondents at two time points.
Participants and Methods: Based on 24-hour natriuresis, pregnant women (37–40 weeks
gestation) were divided into three groups: normal salt intake (NS; <5.75 g/day, N=12), high salt
intake (HS; 5.75 – 10.25 g/day N=36), and very high salt intake (VHS; >10.25 g/day, N=17). In all
subjects, microvascular reactivity of the forearm skin was measured in response to vascular
occlusion, local heating (LTH) and acetylcholine iontophoresis (AChID), as well as flow-mediated
dilation (FMD) of the brachial artery. The following biomarkers of endothelial function and
oxidative stress were measured: serum concentrations of nitric oxide (NO), endocan, 8-isoprostaglandin F2a (8-iso-PGF2a), thiobarbituric acid reactive substances (TBARS) and the ferric
reducing ability of plasma. Ultrasound indices of fetoplacental function, plasma renin activity,
aldosterone concentration, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor
(PlGF) were measured in serum, and vascular endothelial growth factor C (VEGF-C) and matrix
metalloproteinase 9 (MMP-9) concentration were measured in placental tissue.
Results: Brachial artery FMD, microvascular AChID and LTH were significantly reduced in the
VHS group compared to the NS group, and LTH was also significantly reduced in the NS group
compared to the HS group. NO was significantly reduced in both the HS and VHS groups compared
to the NS group. Endocan, 8-iso-PGF2a and TBARS were significantly increased in the VHS group
compared to the NS group. Fetal middle cerebral artery (MCA) pulsatility index was significantly
reduced in the HS and VHS groups compared to the NS group. Aldosterone concentration showed
a tendency to increase with salt intake, and the sFlt-1/PlGF ratio was significantly reduced in the
9. SUMMARY
76
VHS group compared to the NS group. The concentration of VEGF-C and MMP-9 did not differ
between the observed groups.
Conclusions: High dietary salt intake is associated with reduced endothelium-dependent NOmediated vasodilatation in the peripheral microcirculation and macrocirculation of healthy
pregnant women and increased oxidative stress. Furthermore, high salt intake is associated with
decreased fetal MCA pulsatility, but also with increased aldosterone concentration, decreased
(more favorable) sFlt-1/PlGF ratio and unchanged markers of placental remodeling. |
