RESUMO
BACKGROUND: Pre-eclampsia is a potentially serious condition that still accounts for significant morbidity and mortality for the affected mother and neonate. Although the pathogenesis is not fully understood, it is now widely accepted that vascular endothelial dysfunction is the most important and principal event in the pathophysiology of the disease. The aims of our study were to compare serum soluble endoglin levels at week 13 in normotensive pregnant women and in high-risk women, to determine whether the maternal plasma soluble endoglin concentration at 26 weeks is increased in pregnancies that subsequently develop pre-eclampsia, and to identify if soluble endoglin measurement improves the results of screening for pre-eclampsia. METHODS: This work was conducted in 60 healthy pregnant controls and 110 pregnant women at high risk for pre-eclampsia. Gestational age was confirmed by date of last menstrual period and first trimester ultrasound. The time of onset of pre-eclampsia was defined as the time of first elevated blood pressure or urinary protein measurement leading to the diagnosis. Blood samples were collected for measurement of soluble endoglin and other routine laboratory tests, including measurement of urinary proteins. Serum soluble endoglin was estimated by sandwich enzyme-linked immunosorbent assay. RESULTS: There was a highly significant increase in serum soluble endoglin in high-risk women compared with controls at week 13 (P < 0.001). Further determination of soluble endoglin revealed a more significant increase in women who developed early-onset pre-eclampsia compared with those who developed late-onset pre-eclampsia. Moreover, a significant positive correlation was found between soluble endoglin and both diastolic blood pressure and total urinary protein, ie, severity of pre-eclampsia. CONCLUSION: Estimation of serum soluble endoglin at gestational week 13 could be used as a sensitive screening test for women at high risk of developing pre-eclampsia prior to onset of its clinical manifestations, which could potentially improve the outcome of pregnancy.
RESUMO
INTRODUCTION: This study aimed at determination of circulating soluble interleukin-2 receptor (IL-2 R) alpha in the sera of patients with systemic lupus erythematosus (SLE) and correlating the level of expression of these receptors with the SLE disease activity. MATERIALS AND METHODS: The study included 55 patients with SLE and 20 healthy volunteers as controls. The following investigations were done: serum complement component 3, complement 4, erythrocyte sedimentation rate, complete blood count, serum creatinine, creatinine clearance, 24-hour urinary protein, urinalysis, and serum soluble IL-2R alpha level. Kidney biopsy was performed and examined with light microscopy for patients with lupus nephritis by a single pathologist blinded to the clinical activity of the disease. The results were analysed in relation to the clinical activity index of systemic lupus activity measure (SLAM). RESULTS: The study showed that levels of soluble IL-2R alpha were significantly higher in the total group of patients with SLE compared to the controls (P < .001). Furthermore, serum IL-2R alpha levels were significantly higher in patients with lupus nephritis than those without nephritis. There were strong positive correlations between IL-2R alpha levels and the SLAM score, histological activity index, erythrocyte sedimentation rate, and 24-hour urinary protein excretion. Also, significant inverse correlations with complement 3 and packed cell volume was observed (r = 0.738; r = 0.669; r = 0.328; r = 0.705; r = -0.444; r = -0.420, respectively). CONCLUSIONS: Serum soluble IL-2R alpha is a reliable marker of disease activity in patients with SLE and could be used as an indicator of early renal involvement with the possibility of using it for follow-up.
