[Plasma concentration of biochemical markers in pre-eclampsia-eclampsia and its association with the severity of the disease]

Abstract

It has been demonstrated that the concentrations of molecules related to endothelial cell dysfunction, coagulation and vasoconstriction are altered in preeclamptic patients, but they have not been evaluated in their relationship with the severity of preeclampsia.

Objective: To determine the relationship between the plasmatic concentrations of fibronectin ED1+, antithrombin III, prostacyclin and thromboxane, and the severity of preeclampsia.

Methods: Peripheral blood was collected from 215 women in the third trimester of pregnancy, admitted to the Luis Castelazo Ayala Gynecology and Obstetrics Hospital with mild preeclampsia (n = 103), severe preeclampsia (n = 71), HELLP syndrome (n = 25) or eclampsia (n = 16). Plasma aliquots were stored at -70 degrees C until analysis. Fibronectin ED1+ was measured by ELISA; antithrombin III activity was determined using an automated amidolytic technique, and the concentrations of the stable metabolites 6-keto-prostagiandin F1a and thromboxane B2 were measured by RIA. Statistical analysis included ANOVA and logistic regression.

Results: Maternal age was similar in all participants. Prematurity and low birth weight were present in the patients with severe preeclampsia, HELLP and eclampsia. The values for fibronectin were similar among the 4 groups of patients. Antithrombin III activity was significantly lower in the patients with HELLP. In patients with severe preeclampsia and HELLP syndrome, prostacyclin (Pc) and thromboxane (Tbx) concentrations were significantly higher, and the Pc/Tbx ratio was lower than in patients with mild preeclampsia. Those patients who had the highest thromboxane levels and the lowest Pc/Tbx ratio had a higher chance to develop severe preeclampsia or HELLP (5 times), as well as to have premature babies (12 times) than patients with mild preeclampsia.

Conclusions: Our study demonstrates relationships among antithrombin III activity, prostacyclin and thromboxane concentrations, and the severity of preeclampsia. These compounds were significantly more altered in patients with HELLP syndrome, probably due to a higher organic and vascular dysfunction. Plasma determination of these compounds may be valuable as a tool in the screening of preeclampsia, and as an indicator of severity of the disease.