RESUMO
BACKGROUND: The aim of this cross-sectional study was to investigate inflammatory biomarkers in urine samples of 24 fetuses with posterior urethral valve (PUV) collected at 22 ± 4 weeks of gestation and to compare the findings with measurements in urine samples of 22 male healthy preterm neonates at 23 ± 4 weeks (control group). METHODS: Inflammatory biomarkers in urine were measured using a cytometric bead array [interleukin (IL)-2, IL-4, IL-6, IL-10, interferon (IFN)-γ, soluable tumor necrosis factor receptor (TNFR) 1, sTNFR2, monocyte chemoattractant protein-1/chemokine ligand 2 (MCP-1/CCL2), eotaxin/CCL11 and interferon gamma-induced protein/10/C-X-C motif chemokine 10 (IP-10/CXCL10)] and ELISA assays [TNF, IL-8/CXCL8 and transforming growth factor-beta (TGF-ß)]. The Mann-Whitney test was used to compare medians. Markers of glomerular (creatinine) and tubular [beta 2 (ß2)-microglobulin, uromodulin, osmolality] functions were correlated with inflammatory biomarkers (Spearman test). RESULTS: An intense inflammatory profile was identified, with significantly increased concentrations of urinary IL-2, IL-4, IL-6, TNF, sTNFRI, sTNFRII, IFN-γ, MCP-1/CCL2, eotaxin/CCL11 and IL-8/CXCL8 in the PUV group compared to the controls. The same was observed for the anti-inflammatory cytokine IL-10 and for the fibrogenic mediator TGF-ß. In the correlation analysis, ß2-microglobulin positively correlated with the presence of MCP-1/CCL2, sTNFRI and eotaxin/CCL11 and negatively correlated with the presence of creatinine. CONCLUSIONS: This study shows that inflammatory molecules are already increased in fetuses with PUV at the mean gestational age of 22 weeks, suggesting a physiopathological role for inflammation just after the embryological formation of the urethral membrane.
Assuntos
Citocinas/urina , Feto/anormalidades , Lactente Extremamente Prematuro/urina , Uretra/anormalidades , Doenças Uretrais/urina , Biomarcadores/urina , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Testes de Função Renal , Masculino , Gravidez , Ultrassonografia , Uretra/diagnóstico por imagem , Doenças Uretrais/diagnóstico por imagemRESUMO
Objetivos: Evaluar las modificaciones de la velocimetría Doppler en el flujo sanguíneo del tronco de la arteria pulmonar en fetos prematuros expuestos a corticoesteroides. Diseño: Estudio prospectivo. Institución: Instituto Latinoamericano de Salud reproductiva (ILSAR), Lima, Perú. Participantes: Madres con 29 a 36 semanas de edad gestacional y sus fetos. Intervenciones: En gestantes con 29 a 36 semanas de gestación que habían recibido corticoides para madurez pulmonar fetal, se hizo velocimetría Doppler del flujo sanguíneo del tronco de la arteria pulmonar de sus fetos. Principales medidas de resultados: Correlación de los cambios de la velocimetría Doppler con la madurez pulmonar en el neonato. Resultados: Los fetos prematuros que recibieron corticoides no tuvieron complicaciones respiratorias neonatales cuando el índice tiempo de aceleración/tiempo de desaceleración sistólico (TA/TD) fue igual o mayor a 0,57, cuyo valor se alcanzó en fetos con 33 semanas o más y con peso desde 2 000 g. Los valores de TA/TD luego de corticoides tuvieron una correlación estadística alta con las complicaciones respiratorias del RN (p<0,0001). Conclusiones: Después de aplicar corticoides para madurar el pulmón en fetos prematuros, se observó modificaciones en el flujo del tronco de la arteria pulmonar medidos con el índice TA/TD, con valores superiores a los observados para la misma edad gestacional en fetos sin corticoides. La diferencia fue altamente significativa desde la semana 33. El índice TA/TD del tronco de la arteria pulmonar es una herramienta útil para determinar madurez pulmonar.
Objectives: To determine changes in pulmonary artery blood flow Doppler velocimetry in preterm fetuses exposed to corticosteroids. Design: Prospective study. Setting: Instituto Latinoamericano de Salud Reproductiva (ILSAR), Lima, Peru. Participants: Mothers 29-36 weeks of gestation and their fetuses. Interventions: In fetuses of mothers 29-36 weeks of gestation who had received corticosteroids for maturation pulmonary artery blood flow Doppler velocimetry was performed. Main outcome measures: Correlation of Doppler velocimetry changes and neonate lung maturity. Results: Preterm fetuses that received corticosteroids did not present neonatal respiratory complications when systolic acceleration time/deceleration time (AT/DT) index was equal or over 0,57, value obtained in fetuses 33 weeks or more and weight over 2 000 g. AT/DT values following corticosteroids showed high statistical correlation with newborn respiratory complications (p<0,0001). Conclusions: Pulmonary artery blood flow measured with AT/DT index was modified after corticosteroids administration for preterm fetal lung maturation; values were superior to those observed for same gestational age fetuses without corticosteroids. Difference was highly significant starting at week 33. AT/DT index of the pulmonary artery stem is a useful tool to determine pulmonary maturity.