ABSTRACT
OBJECTIVES: To examine soluble E-selectin, L-selectin, P-selectin, ICAM-1, and VCAM-1 levels in normotensive and preeclamptic pregnancies. To determine cut-offs useful for preeclampsia early detection. STUDY DESIGN: A cohort of nulliparous women was recruited at family medicine clinics in Mexico City. Preeclampsia developed in 75 patients; 125 normotensive controls were matched. Adhesion molecules were assessed in serum obtained at 20 gestation weeks and in third trimester pregnancies. Predictive values and odds ratios for preeclampsia development were calculated with the 20 gestation week results. Threshold values were selected based on ROC curves values. RESULTS: In women with subsequent preeclampsia, sL-selectin and sVCAM-1 concentrations were significantly lower, whereas sE-selectin, sP-selectin and sICAM-1 levels were significantly higher, compared with controls at mid-pregnancy (p<0.05). The odds ratio for low sL-selectin was 25.6 (95% CI, 8.9-73.5; cut-off, 1414 ng/ml). The sensitivity, specificity, and positive and negative predictive values of low sL-selectin for preeclampsia development were 84, 90, 39, and 98%, respectively, whereas its sensitivity, specificity, and positive and negative predictive values for severe preeclampsia development (cut-off, 1210 ng/ml) were 100, 98, 60, and 100%, respectively. CONCLUSIONS: Early enhanced activation of endothelial cells, platelets and leukocytes seem to be present in preeclamptic patients, especially in those that develop severe preeclampsia. Low sL-selectin levels at 20 gestation weeks may be an indicator of preeclampsia development.
Subject(s)
Cell Adhesion Molecules/blood , Pre-Eclampsia/blood , Pre-Eclampsia/diagnosis , Pregnancy Trimester, Second/blood , Adult , Biomarkers/blood , Case-Control Studies , Cohort Studies , E-Selectin/blood , Female , Humans , Intercellular Adhesion Molecule-1/blood , L-Selectin/blood , P-Selectin/blood , Predictive Value of Tests , Pregnancy , Sensitivity and Specificity , Vascular Cell Adhesion Molecule-1/bloodABSTRACT
I. Introducción, Justificación, Descripción del problema, objetivos del trabajo, Marco teórico (La diabétes mellitus como enfermedad, Conceptos, Clasificación, Etiología), Etiopatogenia de las lesiones del pie (Macroangiopatia diabética,Microangiopatía diabética, La neuropatía Diabética, La osteoartropatía diabética, La infección podal, Las lesiones del pie), Tratamiento médico, Profilaxis de las lesiones podales del pie diabético, Valoración de enfermería, Signos y síntomas del pie diabético, Guía de educación al paciente, Cuidados de los pies del paciente diabético; II. Diseño metodológico; III. Conclusiones, Recomendaciones, Bibliografía
