Preeklampsiada Ve Düşük Riskli Gebeliklerde Maternal Serum Homosistein, Yüksek Sensitif C- Reaktif Protein, İnterlökin-6, İnsülin Direncini Hemostatik Değerlendirme İndeksinin Karşılaştırılması

Yıl 2013, Cilt: 10 Sayı: 37, 1534 - 1541, 01.01.2013

Reyyan Özcan Temizkan Elif Gül Yapar Eyi Ebru Aslan Seyhan Çıkman

Öz

Amaç: Preeklampsi tüm dünyada gebeliklerin %3.9'unu etkilemekte olan etyolojisi tam bilinmeyen endotelyal bir bozukluktur. Preeklampsi kapiller kaçak, fetal gelişme geriliği, kanama profilinde bozulma ve çoklu organ yetmezliğine yol açabilir. Bu çalışmanın amacı, vücut kitle indeksi ve fetal doğum ağırlıkları ile insülin direncinin hemostatik değerlendirme indeksi HOMA-IR , maternal serum homosistein, interlökin- 6 ve yüksek sensitif Creaktif protein düzeylerini düşük riskli gebelerle hafif ve ağır preeklamptik gebelerde karşılaştırmaktır.Gereçler ve Yöntem: Olgu kontrol çalışması olarak Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma hastanesi Perinatoloji Kliniğinde yapılmıştır. III.trimesterde ve 27- 40. gebelik haftalarında toplam 174 gebe çalışmaya dahil edilmiştir. Çalışma, Ulusal Çalışma Grubu Yüksek olarak Kan Basıncı Eğitim Programı 2000'nin semasına göre tanımlanmış 33 ağır preeklamptik, 30 hafif preeklamptik olan ve 111 sağlıklı düşük riskli gebeden oluşmuştur. Anormal glukoz tarama testi, bozulmuş tiroid fonksiyon testi, aktif infeksiyonu olan ve on gün içinde kortikosteroid alan gebeler çalışmadan çıkarılmıştır.Bulgular: Vücut kitle indeksi hafif preeklamptiklerde 30.4+5.6 ve ağır preeklamptiklerde 30.2+5.2 kontrol grubuna göre 27.3+4.0 anlamlı olarak yüksek bulundu. Medyan değerler ve aralıkları esas alındığında; serum homosistein, hs-CRP, IL-6 düzeyleri hafif preeklampside sırası ile; 7.8 3.6-13.0 , 7.0 1.8-45.0 ,3.1 2.0-24.0 ve ağır preeklampside 7.1 2.4-24.0 , 12.0 2.0-37 6.2 2.0-12.0 kontrol grubuna göre 5.0 2.3-19.0 , 3.9 0.7-23.0 , 2.0 2.0- 31 , anlamlı oranda yüksekti. p

Anahtar Kelimeler

Homosistein, preeklampsia, insülin direncinin homeostatic değerlendirme indeksi, interlökin 6, yüksek sensitif C reaktif protein

Comparison Of Maternal Serum Homocystein, High Sensitive C-Reactive Protein Interleukin-6, Homeostatic Model Assessment Of Insulin Resistance In Preeclampsia And Low Risk Pregnancy

Öz

Introduction/Background: Preeeclampsia is an endothelial disorder of unknown etiology affecting 3.9% of pregnancies worldwide. In some patients, the disease may manifest itself in the form of either a capillary leak, fetal growth restricton or a spectrum of abnormal hemostasis with multiple organ dysfunction. This study was designed to examine the relationship between maternal demographics and body mass index BMI together with maternal serum homocysteine levels, homeostatic model assesment of insulin resistance HOMA-IR , high sensitive C-reactive protein hs CRP , interleukin-6 levels to find a correlation with birthweight in mild and severe preeclampsia without HELLP Syndrome compared with controls.Materials and Method: A case control study was conducted in Zekai Tahir Burak Women Health Education and Research Hospital, Perinatology Clinic ; Ankara, Turkey. After informed consent, a total of 174 pregnant women at third trimester 27-40 weeks were enrolled which included 33 diagnosed cases of severe preeclampsia and 30 diagnosed cases of mild preeclampsia according to the schema of the Working Group on the National High Blood Pressure Education Programme 2000 and 111 healthy low risk pregnant women as controls. Patients with diabetes, abnormal 50 gram glucose screening tests, abnormal thyroid function active infection ,who were given corticosteroids in the previous 10 days were excluded from the study.Results: BMI was found to be higher in mild: 30.4+5.6, and severe : 30.2+5.2 preeclamptic women compared with controls: 27.3+4.0. In terms of median values, plasma homocysteine levels , hs-CRP, IL-6 were significantly higher in mild 7.8 3.6-13.0 , 7.0 1.8-45.0 ,3.1 2.0-24.0 and severe pre-eclamptic women 7.1 2.4-24.0 , 12.0 2.0- 37 6.2 2.0-12.0 as compared to controls 5.0 2.3-19.0 , 3.9 0.7-23.0 ,2.0 2.0-31 , respectively p0.05 . Birthweight was lowest in severe preeclampsia.Conclusion: In preeclamptic women, birthweight was found to be decreased with an increase in the markers of inflammation, IL-6, hs-CRP and homocystein.

Anahtar Kelimeler

Homocysteine, preeclampsia, insulin resistance homeostatic model assesment, interleukin- 6, highly sensitive c reactive protein

Kaynakça

• Redman CWG. Preeklampsia: A multi- stress disorder. Rev. Med Interne 2011;32(1):41-4
• Ertaş IE, Kahyaoglu S, Yılmaz B, Özel M, Sut N, Güven MA, Danısman N. Association of maternal serum high sensitive C-reactive protein level with body mass index and severity of pre-eclampsia at third trimester. J Obstet Gynaecol Res 2010;36(5):970-7
• Pennington KA, Schlitt JM, Jackson DL, Schulz LC, Schust DJ. Preeclampsia: multiple approaches for a multifactorial disease. Dis Model Mech 2012;5(1):9-18
• Güven MA, Coşkun A, Ertaş IE, Aral M, Zencirci B, Oksuz H. Association of maternal serum CRP, IL-6, TNF-alpha, homocysteine, folic acid and vitamin B12 levels with the severity of preeclampsia and fetal birth weight. Hypertens Pregnancy 2009;28(2):190-200
• Mirzaie F, Shorbaf FR, Kazeronie AH. Association of maternal serum c- reactive protein levels with severity of preeclampsia. Acta Medica İranica 2009;47(4):293-6
• Teran E, Escudero C, Calle A. C-reactive protein during normal pregnancy and preeclampsia. Int J Gynaecol Obstet 2005;89(3):299-300
• Stefanovic M, Vukomanovic P, Milosavljevic M, Kutlesic R, Popovic J, Tubic-Pavlovic A. Insulin resistance and C-reactive protein in preeclampsia. Bosn J Basic Med Sci 2009;9(3):235-8
• Lamarca B, Brewer J, Wallace K. IL-6-induced pathophysiology during pre-eclampsia: potential therapeutic role for magnesium sulfate? Int J Infereron Cytokine Mediator Res 2011;2011(3):59-64
• García RG, Celedón J, Sierra-Laguado J, Alarcón MA, Luengas C, Silva F, Arenas-Mantilla M, López-Jaramillo P. Raised C-reactive protein and impaired flow-mediated vasodilation precede the development of preeclampsia. Am J Hypertens 2007;20(1):98-103
• Teran E, Escudero C, Moya W, Flores M, Vallance P, Lopez-Jaramillo P.Elevated C-reactive protein and pro-inflammatory cytokines in Andean women with pre-eclampsia. Int J Gynaecol Obstet 2001;75(3):243-9
• Açılmış YG, Dikensoy E, Kutlar AI, Balat O, Cebesoy FB, Ozturk E, Cicek H, Pence S. Homocysteine, folic acid and vitamin B12 levels in maternal and umbilical cord plasma and homocysteine levels in placenta in pregnant women with pre-eclampsia. J Obstet Gynaecol Res 2011;37(1):45-50
• Greer IA, Lyall F, Perera T, Boswell F, Macara LM. Increased concentrations of cytokines interleukin - 6 and interleukin -1 receptor antagonist in plasma of women with preeclampsia: a mechanism for endothelial dysfunction? Obstet Gynecol 1994;84(6):937-40
• Makedos G, Papanicolaou A, Hitoglou A, Kalogiannidis I, Makedos A, Vrazioti V, Goutzioulis M. Homocysteine, folic acid and B12 serum levels in pregnancy complicated with preeclampsia. Arch Gynecol Obstet 2007;275(2):121-4
• Khosrowbeygi A, Ahmadvand H. Circulating levels of homocysteine in preeclamptic women. Bangladesh Med Res Counc Bull 2011;37(3):106-9
• Hauth JC, Clifton RG, Roberts JM, Myatt L, Spong CY, Leveno KJ, Varner MW, Wapner RJ, Thorp JM Jr, Mercer BM, Peaceman AM, Ramin SM, Carpenter MW, Samuels P, Sciscione A, Tolosa JE, Saade G, Sorokin Y, Anderson GD. Maternal insulin resistance and preeclampsia. Am J Obstet Gynecol 2011;204(4):327-333
• Rogvi R, Forman JL, Damm P, Greisen G. Women born preterm or with inappropriate weight for gestational age are at risk of subsequent gestational diabetes and pre-eclampsia. PLOS One 2012;7(3):e34001
• Xiong X, Demianczuk NN, Saunders LD, Wang FL, Fraser WD. Impact of preeclampsia and gestational hypertension on birth weight by gestational age. Am J Epidemiol 2002;155(3):203-9