Evaluation Of Impaired End-organs In Preeclampsia

Preeclampsia,a pregnancy-specific complication occurring in the second half of human pregnancy and one leading causes for perinatal mortality and morbidity,is characterized by the onset of hypertension and proteinuria.The etiology remains elusive although much has been achieved in understanding the pathophysiology and pathogenesis of preeclampsia in the recent years.End-organs damage is the major effect of preeclampsia.For example,headache,visual disturbance,serum elevated liver enzymes,urinary protein,cardiovascular disorders,eclampsia,epigastric pain,heart failure,renal failure,even death.Fetal growth restriction,asphyxiate,fetal death are the result in fetus.Terminate the pregnancy is the only way to cure the disease.When to terminate the pregnancy should consider not only mother but also fetus.Closely monitoring the functions of end-organs is essential to ascertain the appropriate timing of pregnancy termination to avoid further organ damage and to improve fetal and maternal outcomes.B-type natriuretic peptide(BNP) is a 32-amino acid polypeptide that is secreted with the inactive amino-terminal pro B-type natriuretic peptide(NT-proBNP) from the left and right cardiac ventricle in response to ventricular volume expansion and pressure overload.BNP induces diuresis and vasodilation.Serum NT-proBNP elevated in people with heart failure,dyspnea,myocardial infarction.Serum NT-proBNP levels are in accordance with the severity of heart failure and myocardial ischemia.Heart Fatty Acid Binding Protein(H-FABP) is a low-molecular mass(12-15KDa), cytoplasmic proteins,existed in myocardial cytoplasmic.H-FABP is involved in the delivery of fatty acyl coenzyme A,active in oxidation processes,which generate energy in the mitochondria.H-FABP is released into the circulation after myocardial ischemic damage.Serum H-FABP elevated in people with acute myocardial infarction,heart failure and unstable argina.Lipocalin-2(Neutrophil Gelatinase-associated Lipocalin,NGAL) is a family of soluble proteins with eight-standed,β-barrel structure.Lipocalin-2 are carrier proteins for small hydrophobic molecules including iron.The role of lipocalin-2 is bacteriostasis apoptosis,and tissure differentiation relies on its ability to transport iron in and out of cells.In recent years,it has been discovered that the change of lipocalin-2 concentrations is specific and sensitive marker in acute renal injury.It can provide guidance for prevent and treat with acute kidney injury quickly.However,there is no publication regarding the alterations of NT-proBNP in preeclampsia in Chinese women and no publication regarding the alterations of H-FABP or Lipocalin-2 in preeclampsia have been published.To obtain insight into the significance of NT-proBNP in normal pregnancy and in preeclampsia,we determined the concentrations of NT-proBNP in sera of preeclampsia women,age-and gestational age-matched controls with normal pregnancy and age-matched non-pregnant controls. To obtain insight into the significance of H-FABP and Lipocalin-2 in preeclampsia,we determined the concentrations of H-FABP and Lipocalin-2 in sera of preeclampsia women and age-matched pregnant controls.Objectives:To clarify the alterations in circulating NT-proBNP,H-FABP and Lipocalin-2 in preeclampsia.Methods:27 healthy non-pregnant women,27 healthy pregnant women at third trimester and 26 women with preeclampsia were recruited and blood samples were taken.Concentrations of serum NT-proBNP were measured with enzyme-linked immuno-absorbent assay(ELISA).40 healthy pregnant women,40 women with preeclampsia were recruited and blood samples were taken.Concentrations of serum H-FABP and Lipocalin-2 were measured with ELISA.Results:There were significant differences in serum NT-proBNP(P=0.001) among non-pregnancy,normal pregnancy and preeclampsia.Serum NT-proBNP was significantly higher in preeclampsia than non-pregnancy(P=0.002) and normal pregnancy(P=0.001).There were no significant differences in serum NT-proBN (P=0.806) among non-pregnancy and normal pregnancy.Serum NT-proBNP was significantly higher in mild preeclampsia than severe preeclampsia(P=0.044).There were no significant differences in serum H-FABP(P=0.845) and Lipocalin-2(P=0.645) among pregnancy and preeclampsia.Conclusion:Elevated circulating NT-proBNP levels are demonstrated in preeclampsia. NT-proBNP levels are elevated significantly in mild preeclampsia than in severe preeclampsia.NT-proBNP increased with the lowering of blood pressure effect may be the ardiovascular system of the body's stress response to pathophysiological changes. Serum H-FABP and Lipocalin-2 are not elevated in preeclampsia,indicating H-FABP and Lipocalin-2 are not a sensitive biomarker of end-organs damage in preeclampsia.