阿司匹林预防慢性高血压叠加子痫前期：调控作用与研究新进展

Aspirin for Prevention of Chronic Hypertension Complicated with Preeclampsia: Regulatory Effects and New Research Progress

摘要: 慢性高血压是子痫前期独立的、主要的危险因素，慢性高血压叠加子痫前期是妊娠期高血压疾病中极具挑战性的高危亚型，其发病病理进程融合了慢性高血压血管基础损伤与子痫前期胎盘源性病理改变的双重特征，导致孕产妇心肾靶器官衰竭、胎盘早剥及胎儿生长受限、宫内窘迫等严重不良母婴结局风险明显升高，阿司匹林作为经典的抗血小板与抗炎药物，凭借其多靶点、多通路的药理调控作用，成为该疾病一级、二级预防的核心用药，可通过抑制血小板异常活化、修复血管内皮功能、调节炎症级联反应及凝血纤溶系统平衡，从源头干预疾病发生、发展。近年来，随着精准医学、循证医学与分子生物学技术的发展，阿司匹林在高危预防人群分层、用药方案优化、联合干预策略及抵抗机制等方面的研究取得诸多新进展。结合国内外最新研究成果，系统阐述了阿司匹林预防慢性高血压叠加子痫前期的作用机制、临床应用新规范、疗效与安全性评价，为孕产妇健康预防治疗策略制定提供参考依据。

Abstract: Chronic hypertension is an independent and major risk factor for preeclampsia. Chronic hypertension superimposed with preeclampsia represents a highly challenging and high-risk subtype of hypertensive disorders in pregnancy. Its pathological progression combines the dual characteristics of underlying vascular damage from chronic hypertension and placental-origin pathological changes of preeclampsia, significantly increasing the risks of severe adverse maternal and fetal outcomes such as maternal cardiac and renal organ failure, placental abruption, fetal growth restriction, and intrauterine distress. Aspirin, as a classic antiplatelet and anti-inflammatory drug, has become a core medication for primary and secondary prevention of this condition due to its multi-target and multi-pathway pharmacological regulatory effects. It intervenes in the onset and progression of the disease at its source by inhibiting abnormal platelet activation, repairing vascular endothelial function, modulating inflammatory cascade reactions, and balancing the coagulation-fibrinolysis system. In recent years, with advances in precision medicine, evidence-based medicine, and molecular biology, significant progress has been made in research on aspirin regarding risk stratification of high‑risk populations, optimization of dosing regimens, combined intervention strategies, and mechanisms of resistance. Integrating the latest domestic and international research findings, this article systematically elaborates on the mechanisms of action, updated clinical application guidelines, and evaluations of efficacy and safety of aspirin in preventing chronic hypertension superimposed with preeclampsia, providing a reference for the development of maternal health prevention and treatment strategies.