Preeklamside plazma homosistein ve paraoksonaz düzeylerinin araştırılması
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Date
2009
Authors
Altun, Oktay
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Plazma paraoksonaz düzeyinde azalma ve hiperhomosisteinemi ile ilişkili olan endotelyal disfonksiyon, preeklampsinin temel unsurudur. Çalışmamızın amacı ağır preeklamptik gebelerde plazma homosistein ve paraoksonaz düzeylerini saptamak, homosistein ile paraoksonaz arasındaki ilişkiyi araştırmaktır.Mayıs 2007 ile Mayıs 2008 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum polikliniğine başvuran, 26. gebelik haftasından büyük, eylemde olmayan 30 ağır preeklamptik ve 30 sağlıklı gebe çalışmaya dahil edilmiştir. Periferk venöz kanlar her hangi bir ilaç verimeden önce alındı. Gruplar demografik değişkenler, kan basıncı, doğum şekli, fetal doğum ağırlığı, apgar skoru, hematolojik değerler, biyokimyasal değerler, plazma homosistein ve paraoksonaz düzeyleri açısından karşılaştırıldı. İstatistiksel değerlendirmelerde oranların karşılaştırılmasında ki-kare, grup ortalamalarının karşılaştırılmasında t-testi ve Mann-Whitney U testi kullanıldı. Homosistein ve paraoksonaz değerleri için ROC analizinde sensitivite ve spesifitesi anlamlı olan eşik değer noktaları bulundu.Çalışmaya dahil olan ağır preeklamptik ve kontrol grubundaki gebelerin demografik verileri arasında fark yoktu (p> 0.05). Ağır preeklamptik gebelerin ortalama plazma homosistein düzeyi (12,7 ± 3,703 ?mol/L ) kontrol grubundan (5,8140 ± 1,250 ?mol/L) istatistiksel anlamlı olarak yüksekti (p<0,001). ROC analizine göre homosistein ağır preeklampsiyi %98,8 doğrulukla tanımlayabiliyordu. Eşik değeri 7,23 ?mol/L olarak kabul edildiğinde, homosisteinin ağır preeklampsiyi tanımlamaktaki sensitivitesi %100, spesifisitesi %86,7 olarak belirlendi. Ağır preeklamptik gebelerin ortalama paraoksonaz düzeyi (183,31 ± 16,79 U/L) kontrol grubundan (428,59 ± 66,51 U/L) istatistiksel anlamlı olarak düşüktü. (p<0,001) ROC analizine göre paraoksonaz ağır preeklampsiyi %79,1 doğrulukla tanımlayabiliyordu. Eşik değeri 273,4 U/L olarak kabul edildiğinde, bu değerin altında, paraoksonaz ağır preeklampsiyi tanımlamaktaki sensitivitesi %90, spesifisitesi %60 olarak belirlendi. Homosistein düzeyi ile paraoksonaz düzeyi (r= -0,371; p=0,004) arasında negatif yönde bir korelasyon belirlendi.Preeklampsinin etyolojisinde, yüksek plazma homosistein düzeyi ile düşük plazma paraoksonaz düzeyi rol oynuyor olabilir. Preeklampsi etyopatogenezini anlayabilmek için geniş serilerle yapılacak çalışmalara ihtiyaç vardır.
Endothelial dysfunction, which is associated with decreased plasma paraoxonase levels and hyperhomocysteinemia, is an essential component of preeclampsia. Aim of our study was to investigate paraoxonase levels and homocysteine levels in severe preeclamptic women and to study the relationship between homocysteine and paraoxonase. Thirty severe preeclamptic and 30 healthy pregnant women, who were above 26th gestational week and were not in labour, attending to Uludag University Faculty of Medicine Obstetrics and Gynecology outpatient clinic between May 2007 and May 2008 were enrolled in the study. Peripheral venous samples were collected from all women before administration of any medication. Groups were compared for demographic variables, blood pressure, route of delivery, fetal birth weight, apgar scores, hematological parameters, biochemical parameters, plasma homocysteine and plasma paraoxonase levels. For statistical analysis, chi-square test was used for comparing the ratios, t-test and Mann-Whitney U test were used for comparing groups. Cut-off values for homocysteine and paraoxonase levels were reproduced by ROC analysis. No significant difference was seen in demographic data between the group of women with severe preeclampsia and healthy pregnant women (p> 0,05). The mean plasma homocysteine levels of severe preeclamptic patients was significantly higher than the control group (12,7 ± 3,703 μmol/L, 5,8140 ± 1,250 μmol/L, respectively; p<0,001). Homocysteine was found to define severe preeclampsia by using ROC analysis with 98,8% positive predictive value. When cut-off value was set to 7,23 μmol/L, sensitivity and spesificity of homocysteine to detect severe preeclampsia was 100%, 86,7% ,respectively. The mean plasma paraoxonase levels of severe preeclamptic patients (183,31 ± 16,79 U/L) was significantly lower than the control group (428,59 ± 66,51 U/L, p<0,001). Positive predictive value for paraoxonase to represent severe preeclampsia was found 79,1% by using ROC analysis. When cut-off value was taken 273,4 U/L, sensitivity and spesificity of homocysteine to detect severe preeclampsia was 90%, 60%, respectively. Homocysteine levels were found to negatively correlate with paraoxonase levels (r= -0,371; p=0,004). High homocysteine and low paraoxonase levels may play a role in the pathogenesis of preeclampsia. We believe that further investigations with large series are needed to understand etyopathogenesis of preeclampsia.
Endothelial dysfunction, which is associated with decreased plasma paraoxonase levels and hyperhomocysteinemia, is an essential component of preeclampsia. Aim of our study was to investigate paraoxonase levels and homocysteine levels in severe preeclamptic women and to study the relationship between homocysteine and paraoxonase. Thirty severe preeclamptic and 30 healthy pregnant women, who were above 26th gestational week and were not in labour, attending to Uludag University Faculty of Medicine Obstetrics and Gynecology outpatient clinic between May 2007 and May 2008 were enrolled in the study. Peripheral venous samples were collected from all women before administration of any medication. Groups were compared for demographic variables, blood pressure, route of delivery, fetal birth weight, apgar scores, hematological parameters, biochemical parameters, plasma homocysteine and plasma paraoxonase levels. For statistical analysis, chi-square test was used for comparing the ratios, t-test and Mann-Whitney U test were used for comparing groups. Cut-off values for homocysteine and paraoxonase levels were reproduced by ROC analysis. No significant difference was seen in demographic data between the group of women with severe preeclampsia and healthy pregnant women (p> 0,05). The mean plasma homocysteine levels of severe preeclamptic patients was significantly higher than the control group (12,7 ± 3,703 μmol/L, 5,8140 ± 1,250 μmol/L, respectively; p<0,001). Homocysteine was found to define severe preeclampsia by using ROC analysis with 98,8% positive predictive value. When cut-off value was set to 7,23 μmol/L, sensitivity and spesificity of homocysteine to detect severe preeclampsia was 100%, 86,7% ,respectively. The mean plasma paraoxonase levels of severe preeclamptic patients (183,31 ± 16,79 U/L) was significantly lower than the control group (428,59 ± 66,51 U/L, p<0,001). Positive predictive value for paraoxonase to represent severe preeclampsia was found 79,1% by using ROC analysis. When cut-off value was taken 273,4 U/L, sensitivity and spesificity of homocysteine to detect severe preeclampsia was 90%, 60%, respectively. Homocysteine levels were found to negatively correlate with paraoxonase levels (r= -0,371; p=0,004). High homocysteine and low paraoxonase levels may play a role in the pathogenesis of preeclampsia. We believe that further investigations with large series are needed to understand etyopathogenesis of preeclampsia.
Description
Keywords
Preeklampsi, Homosistein, Paraoksonaz, Preeclampsia, Homocysteine, Paraoxonase
Citation
Altun, O. (2009). Preeklamside plazma homosistein ve paraoksonaz düzeylerinin araştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.