The Clinical Significance Of Laboratory Markers Of Hypertensive Disorders In Pregnancy

Objective：Hypertensive disorders in pregnancy (referred to as PIH) is apregnancy-specific diseases,which is one of the most common complicationsof obstetric.The cause of pregnancy-induced hypertension is not yet clear. Itmay be associated with inadequate invasion of the placental extravilloustrophoblasts into the myometrium of the uterus, vascular endothelial celldysfunction, inflammatory response, insulin resistance, nutritional deficiencies,immune response and genetic factor. It is very difficult to distinguish betweenthe preeclampsia and normal pregnancy in the diagnostic tests andpathological performance. So there is a new viewpoint that the systemicpathological state in the pre-eclampsia is not essentially different from thenormal pregnancy but intensified in the extent. The evidence indicates that theproduction of reactive oxygen species increase and inflammatory cytokinesabnormally activate in system in the preeclampsia. It manifests a process ofsystemic non-specific inflammatory response in the preeclampsia and theinflammation status is closely related to the inadequate invasion of theplacental extravillous trophoblasts into the myometrium of the uterus,ischemia and hypoxia of placenta and oxidative stress. These may interactwith each other, damaging the maternal vasculature system then resulting inthe spasm of the vasculature to affecting maternal organs perfusion, finallycausing a series of clinical changes. The decreasing of placental perfusionwould impact on fetal growth and development and nutrient supply whichwould cause the fetal growth restriction. The purpose of this study was explorethe potential etiology and pathogenesis mechanism of PIH throuth theretrospective analysis of the changes of blood count, coagulation function,hepatic and kidney function in PIH.Method:We selected a total of75pregnant women who gave birth in the fourth Hospital of Hebei Medical University in January2012-in December2012.There were a total of45PIH patients in the experimental group included35patients who suffered from the PIH with no complication (refered to simplePIH group) and10patients appeared the obvious complication of PIH(referedto the compliation group). We randomly selected30cases of normal pregnantwomen in the same hospital at the same time for the control group.All of thePIH patients conformed to the diagnosis standard of the unified nationaltextbooks of "Obstetrics and Gynecology" and didn’t suffer from any otherpregnancy complications and medical illness.We recorded the clinical data ofthe three groups of pregnant women and compared the routine blood test,blood coagulation, and liver and kidney function among the groups.All thedata were analyzed by SPSS17.0statistical analysis software.We used mean±standard deviation (x±s) represent the measurement data obeyed normaldistribution and used the median, interquartile range(M, QR) represent thedata not obeyed normal distribution.We used the one-way ANOVA test tocompare all the measurement data obeyed the normal distribution among thethree groups and used nonparametric rank sum test to compare the data notobeyed the normally distribution.P <0.05was indicated statistical significance.Result:1General Description: The average age of the pregnant women in the controlgroup was29.30±3.69years (range24to39years old), the averagegestational age was (39.00,1.25) weeks (29to41weeks). The average age ofthe patients who diagnosed by preeclampsia with no complication group(referred to simple PIH group) was (39.30,1.25) years (range22to44yearsold), the average gestational age was (35.00,4.00) weeks (24to40weeks).The average age of the patients who diagnosed by preeclampsia associatedwith serious complication group (referred to as the complication group) was29.33±4.39years (range23to36years old) and the average gestational agewas31.44±1.30weeks (26to37weeks). The difference of age among thegroups was no statistical significance (P>0.05). The difference of gestationalage was statistical significance (P<0.05). 2The Comparison of laboratory makers among the groups2.1The Comparison of blood routine test among the groups2.1.1White blood cell count: WBC in complication group (11.04±4.89)×10~9/L was higher than that in the control group (8.38±1.50)×10~9/L and thedifference was statistical significance.(P<0.05).WBC in the complicationgroup (11.04±4.89)×10~9/L was higher than that in PIH group(9.29±2.18)×10~9/L,the difference was statistical significance (P<0.05).Therewas no statistical significance (P>0.05) between simple PIH group (9.29±2.18)×10~9/L and the control group (8.38±1.50)×10~9/L.2.1.2Hematocrit: The hematocrit level in simple PIH group (0.34±0.03)%washigher than that in control group (0.32±0.04)%and the difference wasstatistical significance (P<0.05).The hematocrit level in the complicationgroup (0.35±0.04)%was higher than that in control group (0.32±0.04)%andthe difference was statistical significance (P<0.05). There was not statisticalsignificance (P>0.05) between complication group (0.35±0.04)%and simplePIH group (0.34±0.03)%.2.1.3Platelet count: The platelet count in complication group (161.27±85.60)×10~9/L was lower than that in the control group (207.20±52.93)×10~9/Land the difference was statistical significance (P<0.05).The difference ofplatelet count between the complication group (161.27±85.60)×10~9/L and thesimple PIH group (198.97±56.50)×10~9/L was not statistical significance(P>0.05).The difference of platelet count between the simple PIH group(198.97±56.50)×10~9/L and the control group (207.20±52.93)×10~9/L was notstatistical significance (P>0.05).2.2The Comparison of coagulation function among the groups2.2.1Thrombin time: The thrombin time in simple PIH group (14.13±1.15)swas prolonged comparing with the control group (13.31±1.18)s and thedifference was statistical significance (P <0.05).The thrombin time in thecomplication group (15.13±1.41)s was prolonged comparing with the controlgroup (13.31±1.18)s and the difference was statistical significance(P<0.05).The thrombin time in the complication group (15.13±1.41)s was prolonged comparing with the simple PIH group (14.13±1.15)s and thedifference was statistical significance (P <0.05).2.2.2Fibrinogen: The fibrinogen level in complication group (3.18±0.88) g/Lwas lower than that in the control group (3.97±0.38)g/L and the difference wasstatistical significance (P<0.05).The fiberfibrinogen level in the complicationgroup (3.18±0.88)g/L was lower than that in the simple PIH group(3.78±0.64)g/L, the difference was statistical significance (P<0.05).Thedifference of fibrinogen levels between the simple PIH group (3.78±0.64) g/Land the control group (3.97±0.38) g/L was not statistical significance (P>0.05).2.3The Comparison of hepatic and renal function among the groups2.3.1Albumin: The albumin levels in the simple PIH group (26.05±4.20) g/Lwas lower than that in the control group (29.41±2.21) g/L and the differencewas statistical significance (P <0.05). The albumin levels in the complicationgroup (23.69±7.93) g/L was lower than the control group (29.41±2.21) g/Land the difference was statistical significance (P <0.05).The difference of thealbumin level between the complication group (23.69±7.93) g/L and thesimple PIH group (26.05±4.20) g/L was not statistical significance (P>0.05).2.3.2Uric acid: The uric acid level in the simple PIH group (355.63±97.20)umol/L was higher than that in the control group (258.00±56.99) umol/L andthe difference was statistical significance (P <0.05).The uric acid level in thecomplication group (370.60±88.28) umol/L was higher than that in thecontrol group (258.00±56.99) umol/L and the difference was statisticalsignificance (P <0.05).The difference of the uric acid level between thecomplication group (370.60±88.28) g/L and the simple PIH group(355.63±97.20) umol/L was not statistical significance (P>0.05).Conclusion:1The white blood cell count in the complication group was higer thanthat in the simple PIH group and the control group, suggesting inflammatorystate of the patients in the complication group decreased than simple PIHgroup and the control group. 2The hematocritthe in the simple PIH group and the complication groupare higher than that in the control group,suggesting the PIH patients appearhemoconcentration compared with the normal pregnant women.3The platelet level in the complication group patients was significantlydecreased than normal pregnant women.4Thrombin time prolonged and the level of Fibrinogen reduced alongwith the disease get worse, which prompted PIH appearing fibrinolyticabnormality and increasing the hemorrhagic tendency.5PIH patients appeared hypoproteinemia and hyperuricemia comparingwith normal pregnancy.