A Study On The Correlation Between STBM And The Pathogeny Of The Early-Oneset Severe Preeclampsia

Objective:⑴To evaluate the change of the levels of STBM in the placenta and serum of the patients with severe preeclampsia and the morbidity of severe preeclampsia.(2)To evaluate the pathogeny between early-oneset and late-oneset severe preeclampsia may be different.Methods:⑴The study subject:①The early-oneset severe preeclampsia group:15 patients with early-oneset severe preeclampsia who had prenatal examinations and delivered in the Obstetrics of the Second Hospital of HeBei Medical University were selected from November 2006 to June 2007.Severe preeclampsia before 34w is early-oneset. Diagnosis criteria of severe preeclampsia were as follows:blood pressure≥160/110mmHg; proteinuria≥2.0g/24hours or proteinuria of ++; serum creatinine>106μmol/L; platelet count<100×109/L; microangiothic hemolysis ( elevation of serum LDH ) ; elevation of serum ALT or AST; persistent headache orother disturbances of cranial nerve or vision ; persistent discomfort of the epigastrium. Mean age of patients with early-oneset severe preeclampsia was 30.88±4.30 years old(24 to 39 years old);Mean weeks of gestation of them was 32.20±1.08 weeks(31 to 33+5 weeks).②The late-oneset severe preeclampsia group: 15 patients with late-oneset severe preeclampsia were selected to serve as the control group, Severe preeclampsia after 34w is late-oneset.The diagnosis criteria of severe preeclampsia same as above. Mean age of patients with late-oneset severe preeclampsia group was 30.41±6.14 years old(23 to 40 years old);Mean weeks of gestation of them was 36.21±1.36 weeks(34 to 39+5 weeks).③normal pregnancy group: 10 normal pregnancy march with the two groups were randomly selected. All groups without multi gestations ,chronic hypertension,diabetes,heart disease,chronic renal disease,chronic liver disease and immune disease.⑵Sample collecting:3mL of anconeal median venous blood was collected from the study subjects,the blood sample(after separating serum) was preserved for assaying the serum level of TPA which is the marker of STBM.The placental tissues were prepared into homogenative fluid for assaying relative concentrations of TPA .2mL fasting blood was collected from the early- onset and late-oneset severe preeclampsia group ,which was used to assay the levels of blood urea nitrogen and serum creatinine.24-hour urine was collected for assay the concentration of proteinuria.⑶The experiment methods: To determine the level of TPA in the serum and placenta by means of enzyme-linked immmunosorbent assay(ELISA).The levels of TPA mRNA were test by Real-time RT-PCR.To determine the levels of blood urea nitrogen by means of urease test.To assay the levels of serum creatinine by means of picric acid test.To assay the concentrations of proteinuria in the 24-hour urine by means of bromcresol green test.To analyze the results by means of the SPSS14.0.Results: (1)The placenta TPA concentration in the early-oneset severe preeclampsia(2.04±0.33 ng/mL)were significantly higher than in the late-oneset severe preeclampsia(1.75±0.31 ng/mL)(P<0.05).(2)The placenta TPA mRNA concentration(0.0342±0.0021)in early-oneset severe preeclampsia were significantly higher than those in late-oneset(0.0222±0.0020)(P<0.05).(3)The serum TPA levels in the early-oneset severe preeclampsia (1.88±0.43 ng/mL)were significantly higher than those in late-oneset severe preeclampsia(1.59±0.26 ng/mL)(P<0.05).(4) The serum TPA levels in the early-oneset severe preeclampsia (1.88±0.43 ng/mL) were significantly higher than those in normal groups(32～34w)(1.23±0.13 ng/mL)(P<0.05). The serum TPA levels in the late-oneset severe preeclampsia (1.59±0.26 ng/mL )were significantly higher than those in normal groups(34～36w)(1.27±0.23 ng/mL)(P<0.05).(5) The blood urea nitrogen levels in the early-oneset severe preeclampsia(4.58±1.20 mmol/L)were significantly higher than those in the late-oneset severe preeclampsia ( 3.82±1.42 mmol/L ) (P<0.05).The serum creatinine levels in the early-oneset severe preeclampsia(73.5±10.98 mmol/L)were significantly higher than those in the late-oneset severe preeclampsia(66.87±10.47 mmol/L)(P<0.05).The 24-hours proteinuria concentration in the early-oneset severe preeclampsia were 3.50±2.75g,the 24-hours proteinuria concentrations in the late-oneset severe preeclampsia were all less than 0.15g. The fetus S/D in the early-oneset severe preeclampsia (3.2556±0.47093)were significantly higher than those in the late-oneset severe preeclampsia(2.4956±0.45354)(P<0.05). The systolic blood pressure in the early-oneset severe preeclampsia(167.94±16.30 mmHg)were significantly higher than those in the late-oneset severe preeclampsia(159.70±24.14 mmHg ) (P<0.05).The diastolic blood pressure in the early-oneset severe preeclampsia(111.58±10.57 mmHg)were significantly higher than those in the late-oneset severe preeclampsia(108.52±13.55 mmHg)(P<0.05).(6)In the early-oneset severe preeclampsia,the placenta TPA levels correlated positively with the serum urea nitrogen(r= 0.379,P<0.05) and creatinine levels(r=0.457, P<0.05)and S/D ( r=0.613, P<0.05 ) .In the late-oneset severe preeclampsia, the placenta TPA levels correlated positively with the serum creatinine levels(r=0.230 ,P<0.05).(7) In the early-oneset severe preeclampsia,the serum TPA levels correlated positively with the serum creatinine levels(r=0.459, P<0.05)and the systolic blood pressure(r=0.316, P<0.05)and the diastolic blood pressure(r=0.835, P<0.05).In the late-oneset severe preeclampsia, the serum TPA levels correlated positively with the serum creatinine level(sr=0.240, P<0.05)and S/D(r=0.490, P<0.05) and the systolic blood pressure(r=0.223,P<0.05).Conclusion: (1) The levels of STBM in the serum are significantanly difference between severe preeclampsia and nomal pregnancy .The levels of STBM in the placenta and serum are significantanly difference between early-oneset and late-oneset severe preeclampsia. These indicate the pathogeny between early-oneset and late-oneset severe preeclampsia may be different.(2)In the early-oneset severe preeclampsia,the placenta levels STBM correlated positively with the serum urea nitrogen,creatinine levels and S/D. Confirmed early-oneset severe preeclampsia involving placental dysfunction.which aetiology main placental villus blood vessel paramorphia.Simultaneous determination the level of STBM in serum and the fetus S/D will become index for moniting placental function and clinical pathogenetic condition, predicting the fetus safety and danger intrauterine at early-oneset severe preeclampsia expect therapy.(3)What remains unknown is whether or not increased the level of STBM in serum can be detected in the circulation prior to the onset of clinical disease. Whether or not the level of STBM in serum become index for forcasting pathogenetic is unknown. These all wait for further study.