Preeklampsinin erken tahmininde birinci trimester tarama testleri ile serum PP-13 ve MDA düzeylerinin değerlendirilmesi
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Date
2014
Authors
Asıltaş, Burak
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Preeklampsi (PE), 20. gebelik haftasından sonra ortaya çıkan, proteinürinin eşlik ettiği hipertansiyon (HT) olarak tanımlanmaktadır. PE, gebeliklerin yaklaşık %2-10' unda saptanan, nedeni tam olarak bilinmeyen, ülkemizde anne ölümlerinin en önde gelen nedenidir. Vücudun tüm sistemlerini ilgilendiren sistemik ve kompleks bir sendromdur. Anne ve fetus bir arada etkilenir; fetusta gelişme kısıtlılığı, fetal distres, fetal ölüm ve erken doğum, annede ise renal, hepatik, serebral ve koagulasyon sistemlerinde bozukluklara neden olabilir. Bu sebeple, erken tanınması ve tedavi edilmesi çok önemlidir. Bu çalışma ile anne ve bebeğe ait bazı parametrelerle, PE varlığında arttığı bildirilen oksidatif hasar, birinci trimester ikili tarama parametreleri ve gebelikle ilişkili protein (PP-13) ölçümünün PE hastalığı için klinik tanıya yardımcı ve erken bir biyobelirteç olup olmadığının incelenmesini amaçladık. Çalışmaya ikili tarama testi için laboratuvara başvuran toplam 235 gebe dahil edildi. Antenatal takipleri ve doğum bilgileri Kadın Hastalıkları ve Doğum Kliniğinden takip edilen gebelerden 38' inde PE gelişimi gözlendi. Geriye kalan 197 gebeden, PE hasta grubu ile maternal yaş ve gebelik haftası açısından uyumlu olduğu düşünülen 122 gebe kontrol grubu olarak değerlendirildi. CRL ve NT ölçümleri, transabdominal USG ile; ikili tarama parametreleri, kemiluminesans; PP-13, ELİSA ile, MDA, HPLC ile çalışıldı. Yapılan inceleme sonucunda, PP-13 ve MDA değerleri iki grup arasında anlamlı farklı (PP-13 değerleri PE grubunda düşük, MDA değerleri PE grubunda yüksek) bulundu. Diğer parametrelerde iki grup arasında herhangi bir farklılık saptanmadı. PP-13 ve MDA değerlerinin, PE hastalığının erken dönemde tanısı için yüksek sensitivite ve spesifiteye sahip olduğunu bulundu. Bu çalışmada PE hastalığının erken tanısı ile ilgisinin olabileceğini düşündüğümüz bazı parametrelerde anlamlı değişiklikler saptandı. Gebelerde, bu parametrelerin erken dönemde değişiminin saptanmasının, PE hastalığının önlenmesi veya tedavisinin izlenmesi gibi çeşitli aşamalarda faydalı olabileceği görüşüne varıldı.
Preeclampsia (PE) is defined as.the hypertension (HT) that is accompanied by proteinuria occurring after the 20th week of pregnancy. PE occurs in approximately 2-10% of pregnancies and its exact cause is unknown. PE is the leading cause of maternal death in our country. It is a systemic and complex syndrome that affects the entire body. Mother and fetus are affected together; it may lead to fetal growth restriction, fetal distress, fetal death and preterm delivery in fetus and it may cause disturbances in renal, hepatic, cerebral, and coagulation systems in the mother. Therefore, early diagnosis and treatment is essential. In this study, we aimed to investigate if the usefulness of evaluation of first trimester screenning tests, pregnancy associated protein- 13 (PP-13) and oxidative stress levels in mother together with first trimester antenatal measurements of the fetus in prediction of PE. A total of 235 pregnant women were admitted to the study who applied to laboratory for first-trimester screening test. PE was observed in 38 of the pregnant women from Obstetrics and Gynecology Clinic whose antenatal and birth information was followed. From the remaining 197 pregnant women, 122 patients, which were compatible to the PE patients in terms of maternal and gestational age, were evaluated as the control group. CRL and NT measurements were made by transabdominal ultrasonography, dual scanning parameters were studied, with chemiluminescence, PP-13 was studied with ELISA and MDA was studied with HPLC. The results of the study indicated that, PP-13, and MDA levels were significantly different between the two groups (PP-13 values were lower in the PE group and MDA levels were higher in the PE group). No significant difference was detected between the two groups for other parameters. PP-13 and MDA values were found to have high sensitivity and specificity in early diagnosis of PE disease. In this study, we tried to reveal whether significant changes in some parameters were relevant in early diagnosis of PE disease. The determination of changes in these parameters in pregnant women in early stage of pregnancy might be helpful in prevention or monitoring the treatment of PE.
Preeclampsia (PE) is defined as.the hypertension (HT) that is accompanied by proteinuria occurring after the 20th week of pregnancy. PE occurs in approximately 2-10% of pregnancies and its exact cause is unknown. PE is the leading cause of maternal death in our country. It is a systemic and complex syndrome that affects the entire body. Mother and fetus are affected together; it may lead to fetal growth restriction, fetal distress, fetal death and preterm delivery in fetus and it may cause disturbances in renal, hepatic, cerebral, and coagulation systems in the mother. Therefore, early diagnosis and treatment is essential. In this study, we aimed to investigate if the usefulness of evaluation of first trimester screenning tests, pregnancy associated protein- 13 (PP-13) and oxidative stress levels in mother together with first trimester antenatal measurements of the fetus in prediction of PE. A total of 235 pregnant women were admitted to the study who applied to laboratory for first-trimester screening test. PE was observed in 38 of the pregnant women from Obstetrics and Gynecology Clinic whose antenatal and birth information was followed. From the remaining 197 pregnant women, 122 patients, which were compatible to the PE patients in terms of maternal and gestational age, were evaluated as the control group. CRL and NT measurements were made by transabdominal ultrasonography, dual scanning parameters were studied, with chemiluminescence, PP-13 was studied with ELISA and MDA was studied with HPLC. The results of the study indicated that, PP-13, and MDA levels were significantly different between the two groups (PP-13 values were lower in the PE group and MDA levels were higher in the PE group). No significant difference was detected between the two groups for other parameters. PP-13 and MDA values were found to have high sensitivity and specificity in early diagnosis of PE disease. In this study, we tried to reveal whether significant changes in some parameters were relevant in early diagnosis of PE disease. The determination of changes in these parameters in pregnant women in early stage of pregnancy might be helpful in prevention or monitoring the treatment of PE.
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Keywords
Preeklampsi, Plasental protein 13 (PP-13), Oksidatif stres, İkili tarama testi, Preeclampsia, Placental protein 13 (PP-13), Oxidative stress, Dual screenning test
Citation
Asıltaş, B. (2014). Preeklampsinin erken tahmininde birinci trimester tarama testleri ile serum PP-13 ve MDA düzeylerinin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.