The Correlation Between Liver Function And Hematocrit And Endothelial Dysfunction In Severe Preeclampsia

Objectives：To explore the influence of Hematocrit (HCT) and endothelial dysfunctionindices (endothelin-1(ET-1) and nitric oxide (NO)) to the levels of alanineaminotransferase (ALT), aspartate aminotransferase (AST) and gammaglutamyltranspeptidase (GGT) in severe preeclampsia (SPE).Methods:HCT, ALT, AST, GGT were examined and analyzed in193patients with SPE(including100cases with early onset severe preeclampsia (EOSPE) and93cases withlate onset preeclampsia (LOSPE)), comparing with197normal pregnancy (NP)women and112healthy non pregnancy (HNP) women. The serum levels of ET-1andNO were detected and analyzed in34SPE patients,33NP women and16HNPwomen.Results:1) The serum level of ALT in NP women is higher than HNP women (P=0.038);The serum level of ALT in SPE patients is observably higher than NP and HNPwomen (P=0.003; P=0.000). The AST level in NP women are markedly higher thanHNP women(P=0.002; P=0.000); The GGT level in NP women are markedly lowerthan HNP women(P=0.000); The AST and GGT level in patients with SPE are allmarkedly higher than NP and HNP women（P=0.000; P=0.000; P=0.000; P=0.008).2) According to the upper limit range of the reference scope of level of serumALT, AST and GGT(40u/L,40u/L,50u/L) in our clinical laboratory(including maleand female adult), there were2cases (1.02%),3cases (1.52%) and0cases (0.00%)higher than the reference value in NP women, there were20cases (10.36%),46cases(23.83%) and30cases (15.54%) higher than the reference value in SPE patients.Refer to the95th percentile of the level of serum ALT, AST and GGT (27u/L,26u/L and27u/L) in HNP women (n=112), there are29cases (14.72%),71cases (36.04%)and3cases (1.52%) higher than the reference value in NP women, there are44cases(22.80%),121cases (62.70%), and48cases (24.87%) higher than the referencevalue in SPE patients. According to the95th percentile of the level of serum ALT,AST and GGT (34u/L,37u/L and21u/L) in NP women (n=197), there are27cases(13.99%),59cases(30.57%) and60cases (31.09%) higher than the referencerange in the patients of SPE.3) The serum level of ALT and GGT all show negative correlation withgestational age in SPE patients and NP women, of which SPE patients express moreobvious(SPE: r=-0.266, P=0.000; r=-0.434, P=0.000. NP: r=-0.148, P=0.038；r=-0.136, P=0.050). The ALT and GGT level in EOSPE patients are all dramaticllyhigher than LOSPE patients（P=0.001; P=0.000), while there is no significantdifferences in NP women whose gestational age are matched with EOSPE and LOSPEpatients. There is no obvious correlation with gestational age of AST level in SPEpatients and NP women.4) There are positive correlations between HCT and ALT, HCT and GGT inpatients with SPE (r=0.235, P=0.001; r=0.392, P=0.000). Meanwhile, there is positivecorrelation between HCT and GGT in NP women (r=0.175,P=0.014).5) According to the upper limit range of the reference scope of level of serum ALT,AST and GGT(40u/L,40u/L,50u/L) in our clinical laboratory(including male andfemale adult) as the cut-off point for the34SPE patients, the serum ET-1level of thegroup which has higher serum level of ALT and AST is significantly higher than thegroup which has lower serum level of ALT and AST, there are significant statisticaldifferences(P=0.023, P=0.050); the serum NO level of the group which has higherserum level of GGT was significantly lower than the group which has lower serumlevel of GGT, there is significant statistical differences(P=0.017). Other comparisonshave no significant statistical differences, but they all show higher liver enzyme,higher ET-1level, and lower NO level. Conclusion:1) The serum levels of ALT, AST and GGT in SPE patients are significantlyhigher than in NP and HNP women. The serum levels of ALT and AST in NP womenare higher than in HNP women.2) Our studies find the GGT level in serum of NP women is markedly lower thanHNP women firstly.3) The liver function damage is more serious in EOSPE patients comparing withLOSPE patients.4) Increased HCT levels is a positive correlation factor of hepatic injury in SPEpatients.5) Higher ET-1level and lower NO level is the important influence factor for therelease of liver enzymes in SPE patients. Higher ET-1level mainly influence ALT andAST and lower NO level mainly influence GGT.