Translationale Forschung zur Erforschung der Pathophysiologie der Präeklampsie: Das autonome Nervensystem

Zusammenfassung

Die Präeklampsie ist Ursache einer hohen fetalen und maternalen Morbidität und Mortalität. Die pathophysiologischen Mechanismen sind nicht abschließend geklärt, allerdings sind endotheliale Funktionsstörungen im besonderen Maße an der Entstehung einer Präeklampsie beteiligt. Seit vielen Jahren wird eine kausale Mitbeteiligung des autonomen Nervensystems diskutiert. Zahlreiche Studien, die die Exkretion von Katecholaminen im Urin bzw. im Plasma untersuchten, konnten aufgrund widersprüchlicher Ergebnisse die Rolle des autonomen Nervensystems nicht klären. Erst mikroneurografische Untersuchungen, mit denen die sympathische postganglionäre Muskelnervenaktivität direkt abgeleitet werden kann, zeigten eine sympathische Überaktivität bei präeklamptischen Schwangeren. Darüber hinaus ist selbst bei normotensiven Risikoschwangeren eine Hochregulation des sympathischen Nervensystems (PISO: pregnancy induced sympathetic overactivity) nachweisbar. Ob die Aktivierung des autonomen Nervensystems ein Sekundärphänomen ist, ist nicht abschließend geklärt. Die Lösung dieser Frage könnte helfen, pathophysiologische Mechanismen der Präeklampsie zu verstehen, um dadurch effektivere und kausale Therapieregimes zu finden.

Abstract

Preeclampsia is responsible for a high incidence of fetal and maternal morbidity and mortality. The pathophysiological mechanisms of preeclampsia have still not been fully elucidated, but preeclampsia is associated with endothelial dysfunction. Since many decades, a causal relationship to the autonomic nervous system has been assumed. Several studies have investigated the excretion of catecholamines in urine and plasma. Due to conflicting results, the role of the autonomic nervous system could not be definitively resolved in these studies. However, microneurography has demonstrated a state of overactivity in women with preeclampsia. An additional study has shown that all women at risk for preeclampsia showed a gestational increase in muscle sympathetic nerve activity (MSNA), defined as pregnancy-induced sympathetic overactivity (PISO), which normalized after delivery. However, it remains unclear whether the sympathetic activity precedes preeclampsia or occurs only as a secondary phenomenon. Further consolidated research into the role of the autonomic nervous system might answer this question respecting the pathophysiological mechanism of preeclampsia and contribute to a more effective therapeutic regime.

Präeklampsie - autonomes Nervensystem - sympathische Überaktivität - Mikroneurografie - PISO

preeclampsia - autonomic nervous system - sympathetic overactivity - microneurography - PISO

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