RESUMO
Preeclampsia (PE) is classified as early-onset PE (EOPE) and late-onset PE (LOPE) when present before or after 34 weeks of gestation, respectively. This transversal study aimed to investigate the differences and possible associations existing in the anthropometric, hemodynamic, hematologic, and biochemical profiles of late- and early-onset preeclampsia. The study included 65 volunteers admitted to a tertiary hospital in Brazil: 29 normotensive and 36 with preeclampsia (13 with EOPE and 23 with LOPE). Pregnant women with LOPE presented greater weight gain and borderline increase in body mass index at the end of gestation in relation to the other groups, which is compatible with the metabolic origin, associated with obesity, attributed to this form of the disease. Pregnant women with EOPE presented a borderline reduction in the number of erythrocytes and a significant decrease in the number of platelets, in addition to a significant increase in reticulocytes, serum iron, and ferritin when compared to normotensive pregnant women and pregnant women with LOPE. A significant increase in osmotic stability of erythrocytes was observed in the EOPE group in relation to other groups. Hemodynamic analysis by Doppler ultrasonography of the ophthalmic artery showed that both groups of pregnant women with PE presented alterations compatible with the occurrence of hyperflow in the orbital territory. These hemodynamic changes were associated with changes in hematimetric indices.
RESUMO
BACKGROUND: The aim of this study was to evaluate hepatic Doppler ultrasound (US) indices for steatosis diagnosis and grading, having biopsy as reference. METHODS: Doppler and conventional US were performed in 49 healthy volunteers, without risk factors for nonalcoholic fatty liver disease (NAFLD), and in 49 patients with NAFLD and at least one risk factor: obesity, dyslipidemia and/or diabetes mellitus. Significant alcohol intake and hepatitis B or C were exclusion criteria. NAFLD patients were biopsied, and steatosis severity graded histologically. Portal Venous Pulsatility Index (PVI), Hepatic Artery Resistance Index (HARI) and Pulsatility Index (HAPI) were analyzed in hilum. Hepatic vein waveform pattern (HVWP) was classified as triphasic, biphasic or monophasic. Two pathologists analyzed histological samples. ROC curve defined sensitivity and specificity and multivariate analysis defined an equation for classifying patients. RESULTS: In NAFLD group, 89.79% had histologic criteria for non-alcoholic steatohepatitis (NASH). Mild steatosis was present in 44.89%, moderate steatosis in 38.77% and severe steatosis in 16.32%. In NAFLD group, 65.29% were obese and body mass index (BMI) had significant correlation with steatosis grading (r=0.77; P<0.0001). PVI correlated with presence of steatosis (r=-0.69, P<0.0001) as HVWP (r=-0.61, P< 0.0001). PVI ideal cutoff for predicting steatosis was 0.26 (sensitivity, 91%; specificity, 79.6%). The equation 16.15PVI+1.96HVWP enables to differentiate the healthy and the steatosis patients. HARI and HAPI could not differentiate the healthy from the steatosis group. None of the indices correlated with steatosis grading. CONCLUSIONS: Portal and hepatic vein indices allow non-invasive steatosis diagnosis but are limited to quantify it. Histology remains important for steatohepatitis diagnosis and for steatosis grading.
