Geburtshilfe Frauenheilkd 2000; 60(1): 1-10
DOI: 10.1055/s-2000-10855
ÜBERSICHT
Georg Thieme Verlag Stuttgart ·New York

Die Bedeutung von Stickstoffmonoxid in der Pathophysiologie und Therapie der Präeklampsie*

Nitric Oxide in the Pathophysiology and Treatment of Preeclampsia P. M. Wagner ,  W. Heyl,  W. Rath
  • Frauenklinik für Gynäkologie und Geburtshilfe, Universitätsklinikum der Rheinisch-Westfälischen Technischen Hochschule (RWTH) Aachen
Further Information

Publication History

Publication Date:
31 December 2000 (online)

Also available at
 

Zusammenfassung

Die endotheliale Dysfunktion mit der Folge eines Ungleichgewichtes zwischen vasokonstriktorischen, aggregatorischen Substanzen einerseits und vasodilatatorischen, antiaggregatorischen Substanzen andererseits stellt die pathophysiologische Grundlage hypertensiver Schwangerschaftserkrankungen dar. Bei der Regulation des Vasotonus spielt Stickstoffmonoxid als stärkster endogener Dilatator eine entscheidende Rolle. Als Folge der Endothelzellalteration wird bei Präeklampsie eine Verminderung der endothelialen Stickstoffmonoxid-Synthese vermutet. NO vermindert darüber hinaus die Sensitivität der Thrombozyten gegenüber prokoagulatorischen Substanzen, inhibiert die Leukozytenadhäsion, vermindert die Endothelinfreisetzung und hemmt die Proliferation der glatten Muskelzellen. Zur Bedeutung des endothelialen Stickstoffmonoxid-Synthase-Gens liegen bei Präeklampsie unterschiedliche Untersuchungsergebnisse vor, ebenso zur Expression der endothelialen Stickstoffmonoxid-Synthase in Plazentagewebe und in den Nabelschnurgefäßen hypertensiver und normotensiver Schwangerer. Ebenfalls kontrovers sind bisherige Studienergebnisse zu Konzentrationen von Nitrat und Nitrit in Plasma und Urin. Stickstoffmonoxid-Donatoren wurden bisher in unterschiedlichen Applikationsformen zur Therapie des Schwangerschaftshochdrucks, des HELLP-Syndroms und der uterinen Minderperfusion eingesetzt, ohne daß allerdings derzeit therapeutische Empfehlungen für die Praxis aus diesen Untersuchungen abgeleitet werden können.

Abstract

The spectrum of the hypertensive disorders of pregnancy result from an imbalance between vasoconstrictive agglutinating substances and vasodilating anticoagulative substances. Nitric oxide is the most potent endogenous vasodilator and plays a central role in the regulation of vascular tone. Impaired synthesis of nitric oxide by endothelial cells is assumed to be a central mechanism in the pathophysiology of preeclampsia. Nitric oxide also decreases the sensitivity of thrombocytes to procoagulative substances, inhibits the adhesion of leucozytes, and reduces the release of endothelin and the proliferation of vascular smooth muscle cells. The role of the endothelial nitric oxide synthetase gene and the expression of endothelial nitric oxide synthetase in placental tissue and umbilical vessels in preeclampsia and normal pregnancy is unclear. Nitric oxide donors have been used experimentally in attempts to treat hypertensive disorders of pregnancy but their efficacy is unproved and there are no recommendations for clinical use.

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Dr. med. Peruka M. Wagner

Frauenklinik für Gynäkologie und Geburtshilfe

Universitätsklinikum der

Rheinisch-Westfälischen Technischen Hochschule (RWTH) Aachen

Pauwelsstraße 30

D-52074 Aachen

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