Tumour necrosis factor-alpha in patients with severe preeclampsia with and without HELLP syndrome

ABSTRACT

Tumor necrosis factor-a [TNF- alpha], acytokine produced mainly by macro-phages, is involved in immunoregulation, the modulation of cell growth and differentiation, as well as in the induction of oxygen radicals. This study was designed to investigate whether tumor necrosis factor- alpha [TNF- alpha] is present in maternal plasma in pregnancies associated with severe preeclampsia with and without HELLP syndrome and its concentrations. Fifty patients with severe preeclampsia composed the study group. This group is further subdivided into severe preeclamptic without HELLP syndrome, [n = 37] and severe preeclampsia with HELLP syndrome [n = 13]. A control group composed of 25 pregnant women, some of them were in early labor [n = 11] and the rest [n - 14] were in late pregnancy. Maternal plasma samples for TNF- alpha were taken for all groups. Also, serum creatinine spartate aminotransferase [AST], alanine aminotransferase [ALT] and platelets count to diagnose the presence of HELLP syndrome. TNF-alpha was detected in 80% of the studied group with severe preeclampsia [n = 50], while it was detected only in 13 patients [21%] only in the control groups. Also, the maternal plasma concentration in the severe preeclamptic group was [61 +/- 17] ng/ml and [146 +/- 37] ng/ml in the severe preeclampsic group with HELLP syndrome [n = 13] respectively which were statistically highly significant when compared to maternal plasma levels in the control group [7 +/- 3] ng/ml. There were no positive or negative correlation between TNF- alpha plasma concentrations in both groups and maternal age, gestational age and parity. Also, in the severe preeclamptic group there were no positive or negative correlation between the diastolic blood pressure, the amount of protein urine, the liver enzymes or platelets count and TNF- alpha maternal serum levels. So, we can concluded that tumor necrosis factor-alpha is increased in the plasma of patients with severe pre-eclampsia especially those developing HELLP syndrome. These data are suggestive of a role for abnormal immune activation in the pathophysiologic mechanisms of severe pre-eclampsia with or without HELLP syndrome