RESUMO
PURPOSE: The aim of this study was to evaluate the usefulness of urine concentrations of 12 proteins as a risk parameter for developing preeclampsia (PE). METHODS: A nested case-control study was designed to determine protein concentrations in urine from women predicted to develop PE (WPD-PE) and normotensive pregnancies (controls). Protein profiles were determined at 12, 16 and 20 gestational weeks (GW) using the Bio-Plex Pro human kidney toxicity Panel 1 and Panel 2 (Bio-Rad). Receiver operating characteristic (ROC) curve analyses were performed. Correlations between proteins and clinical parameters at the time of PE diagnosis were also assessed. RESULTS: Significant differences were observed in urine cystatin C (Cys C) levels at 16 and 20 GW and clusterin at 20 GW between WPD-PE and controls (P < 0.05). ROC analysis revealed that Cys C at 16 GW had the highest area under the ROC curve (0.758). At 16 GW, patients with urine Cys C levels above 73.7 ng/mL had eightfold increased odds for developing PE (odds ratio 7.92; 95 % CI 1.3-47.5; P = 0.027). A positive correlation was found between urinary Cys C (at 16 and 20 GW) and leukocyte counts, total proteins, aspartate aminotransferase, alanine aminotransferase, bilirubin and lactate dehydrogenase at the time of PE diagnosis (P value < 0.05). CONCLUSIONS: Urinary Cys C and clusterin showed predictive value for PE development in our cohort. Further studies are needed to validate their use as predictive biomarkers for PE and/or their participation in PE pathogenesis.
Assuntos
Clusterina/urina , Cistatina C/urina , Pré-Eclâmpsia , Adulto , Biomarcadores/urina , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , México/epidemiologia , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/urina , Valor Preditivo dos Testes , Gravidez , Prognóstico , Curva ROC , Medição de Risco , Urinálise/métodosRESUMO
BACKGROUND: Oxidative stress has been related to several conditions during pregnancy (preeclampsia, abortions and premature rupture of membranes); it causes higher sensitivity of the endothelial blood vessel constriction and aggravates the endothelium dependent vasodilatación. OBJECTIVE: To determine the oxidative stress level and histological changes in preeclamptic women's placenta. PATIENTS AND METHOD: Longitudinal and comparative study. There were included 25 patients referred from second level health units (IMSS, ISSSTE and Hospital General de Zacatecas). To evaluate oxidative stress level, a sample of blood and placenta were obtained during delivery and a second sample was taken during mediate puerperium (10 days). RESULTS: In control group, total lipidic peroxide levels in serum were 135.6 +/- 7.3 nmol of MDA/mL of serum, compared with the group of moderate hypertension, which registered 222.0 +/- 35.15 nmol MDA/mL. Total lipidic peroxides in serum during puerperium for control group were 150.4 +/- 30.8 and 183.3 +/- 18.51 nmol MDA/mL for the group of moderate hypertension. Placental lipoperoxidation for control group was 0.40 +/- 0.03 microg MDNg, and of 0.32 +/- 0.03 microg MDN/g for the group of mild hypertension. Patients of moderate hypertension group showed an increase at 34% on placental lipoperoxidation over control group. Placental histological alterations where characterized by vascular remodeling loss, deposits of proteinaceous material and macrophagic process. CONCLUSION: Total lipidic peroxide levels in serum increases during preeclampsia. Histological changes refer uterus-placental ischemia that, probably, induces the oxidative stress.