الفهرس 
PRE-ECLAMPSIAOnly 14 pages are availabe for public view
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Abstract
Pre-eclampsia is a multisystem disorder specific to pregnant women.It is characterized by new onset hypertension which arises in pregnancy after 20 weeks of gestation together with significant proteinuria. It affects about 5% to 7% of pregnancies resulting in substantial maternal and neonatal morbidity and mortality. It is considered severe if blood pressure and proteinuria are increased substantially or symptoms of end-organ damage, including fetal growth restriction occured.
Some previous studies have indicated that pre-eclampsia is associated with endothelial dysfunction, metabolic abnormalities, inflammatory state and atherosclerosis. However, the etiology of this disease remains elusive. Many authors have demonstrated that dysregulation of adipocyte-secreted factors(adipokines) might play an important role in the pathogenesis of pre-eclampsia because of their role in insulin resistance, lipid metabolism and atherosclerosis.
Visfatin, a 52-kDa adipocytokine known as pre-β- cell colony-enhancing factor, is a novel adipokine secreted by fat tissue and macrophages. It shows insulinomimetic effectthrough the activation of an insulin receptorat a different site from that of insulin and has immunoregulatory and metabolic properties. Increased circulating concentrations have been reported in insulin-resistant states. Therefore, visfatincould be implicated in pathogenesis of pre-eclampsia.
In this regard, this study aimed to evaluate the clinical utility of visfatin in diagnosis of pre-eclampsia and assessment of severity of the disease. In addition, the role of visfatin in intrauterine growth restriction was evaluated.
This study was conducted on 40 pre-eclamptic patients; 20 patients with mild pre-eclampsia and 20 patients with severe pre-eclampsia.All patients were re-classified according to presence ofIUGR into 15 pre-eclamptic patientswith IUGR and 25 pre-eclamptic patientswithout IUGR. In addition, 20 healthy pregnant controls and 20 healthy non-pregnant females were included in the study.
All the studied individuals were subjected to full history taking and complete clinical examination. Blood samples were collected for determination of ALT, AST, RBS, BUN, creatinine, CBC and visfatin. In addition, morning urine samples were collected for determination of total urinary proteins Assay of serum visfatin was carried out using an enzyme linked immunosorbent assay technique.
The results of the present study revealed thatpregnant controls had significantly higher plasma levels of visfatin when compared to non-pregnant controls.The study also revealed a highly significant increase in plasma levels of visfatin in pre-eclamptic women when compared to their matched controls.
As regards the relation of visfatin to the severity of pre-eclampsia, presentstudy showed a statistically highly significant increase of visfatin in severe pre-eclampsia in comparsion to mild pre-eclampsia. Moreover, significant positive correlation was also found between visfatin and both SBP and DBP, which are important indices of severity of pre-eclampsia.
The present study also revealed statistically significant increase of visfatin levels in preeclamptic women with IUGR as compared with those without IUGR.
Receiver operating characteristic (ROC) curve analysis was applied to assess the diagnostic utility of visfatin in discriminating pre-eclamptic patients from the control group. The best diagnostic cutoff level for visfatin was 2.5µg/L. This had a diagnostic sensitivity of 97.5 %, specificity 92.5 %, negative predictive value 97.4 %, positive predictive value 92.9 %, and efficiency 95 % andAUC was 0.989.
In addition, when ROC curve analysis was applied to assess the diagnostic performance of visfatin in discriminating severe pre-eclamptic patients from those with mild pre-eclampsia, the best cutoff value was 4.5 µg/L. This had a diagnostic sensitivity of 90%, specificity 60%, negative predictive value 85.7%, positive predictive value 69.2%, and efficiency 75% and AUC was 0.733.
Also, when ROC curve analysis was applied to assess the diagnostic performance of visfatin in discriminating pre-eclamptic females with IUGR from those without IUGR, it was found that the best cutoff value was 6.0 µg/L. This had a diagnostic sensitivity of 60%, specificity 72%, negative predictive value 75%, positive predictive value 56.3%, and efficiency 67.5%and AUC was 0.714.