| Abstract | Cilj: Prikazati značaj pojedinih laboratorijskih parametara u postavljanju dijagnoze kod trudnica sa sumnjom na preeklampsiju i HELLP sindrom u Klinici za ženske bolesti i porode KBC Split, u razdoblju od 1. siječnja 2011. do 31. prosinca 2013. godine.
Pacijenti i metode: U studiju su uključene žene hospitalizirane zbog PE i HELLP sindroma tijekom 2011.-2013. godine. Na temelju podataka dobivenih iz povijesti bolesti Klinike za ženske bolesti i porode KBC Split, analizirana su osnovna demografska obilježja ispitivane skupine trudnica koja su uključivala: dob (godine), gestacijsku dob (tjedni), graviditet (broj trudnoća), paritet (broj porođaja), BMI (kg/m2), sRR (mmHg), dRR (mmHg), proteine, porodnu težinu (gr) te porodnu dužinu (cm). Osim toga, proučavani su i osnovni laboratorijski parametri ispitivanih skupina trudnica što je uključivalo: leukocite, eritrocite, hemoglobin, hematokrit, CRP, fibrinogen, D-dimere, trombocite, AST, ALT, LDH, ureju, kreatinin, urate, ukupne proteine i albumine. Osim što smo računali srednje vrijednosti, također smo uspoređivali skupine međusobno te analizirali razlike tamo gdje smo ih uočili.
Rezultati: Nije pronađena statistički značajna razlika među skupinama prema dobi, gestacijskoj dobi te graviditetu. Statistički značajna razlika je postojala između skupina prema paritetu. Najmanji broj porođaja su imale trudnice iz skupine s PE. Statistički značajna razlika je postojala između skupina prema indeksu tjelesne mase (BMI). Trudnice iz skupine s PE su su statistički imale najviše vrijednosti indeksa tjelesne mase. Prisutna je i statistički značajna razlika između skupina prema vrijednostima sistoličkog i dijastoličkog tlaka. Najviše vrijednosti su prisutne u trudnica s PE, zatim nešto manje u trudnica s HELLP sindromom a najmanje vrijednosti u kontrolnoj skupini. Statistička značajnost u razlikama je pronađena i kod vrijednosti proteina u urinu. Najviše vrijednosti su prisutne u trudnica s PE, vrijednosti ispod njih su imale one s HELLP sindromom a najniže vrijednosti imaju kontrole. Prisutan je statistički značajan zastoj u rastu fetusa kod trudnica s PE i HELLP sindromom u odnosu na kontrole. Statistički značajan porast leukocita je prisutan u HELLP sindromu u odnosu na skupinu s PE i kontrole. Eritrociti, hemoglobin i hematokrit su statistički značajno nižih vrijednosti u trudnica s HELLP sindromom u odnosu na trudnice s PE i kontrole. CRP je statistički značajno viših vrijednosti jedino u odnosu trudnica s HELLP sindromom naspram onih s PE. Fibrinogen i trombociti su značajno nižih vrijednosti u trudnica s HELLP sindromom u odnosu na one s PE i kontrole, dok su vrijednosti D-dimera značajno više u skupini trudnica s HELLP sindromom naspram trudnica s PE i kontrola. Vrijednosti ALT-a i AST-a su statistički značajno više u trudnica s HELLP sindromom u odnosu na one s PE i kontrole. Isto vrijedi i za vrijednosti LDH. Vrijednosti ureje, kreatinina, ukupnih proteina i albumina nisu pokazale statistički značajniju razliku među skupinama. Vrijednosti urata su statistički značajno više u trudnica s HELLP sindromom u odnosu na one s PE i kontrole, te u trudnica s PE u odnosu na kontrole.
Zaključak: Preeklampsija predstavlja čest i važan javnozdravstveni problem. Pravilnim prenatalnim nadzorom mogli bismo na vrijeme prepoznati i što bolje liječiti trudnice s PE i HELLP sindromom. Trudnoća prate određene fiziološke promjene u laboratorijskim pretragama trudnih žena u odnosu na netrudne žene. Trudnice s PE i HELLP sindromom ipak imaju još više izražene patološke promjene serumskih laboratorijskih parametara. Iz većeg skupa pretraga koje se rade prilikom primitka trudnica sa sumnjom na PE ili HELLP sindrom, možda bismo u budućnosti mogli izdvojiti samo neke kao što su: leukociti, CRP, eritrociti, hemoglobin, hematokrit, trombociti, fibrinogen, AST, ALT, LDH i urati, koje imaju veliku statističku značajnost a pritom su jeftinije, brže i jednostavnije za početnu obradu. |
| Abstract (english) | Objective: In this research we analysed the importance of the particular laboratory parameters in pregnant women that are doubted to have preeclampsia and HELLP syndrome, in our clinic, during the period of 3 years (from January 2011 to December 2013).
Design: Retrospective study
Patients and methods: All women with diagnosed PE and HELLP syndrome, hospitalized in our Clinic during 2011.-2013., were included in this study. We analysed the basic demographic characteristics in interrogated pregnant women that included: age, gestational age, pregnancy, parity, BMI, sRR, dRR, proteins, birth weight, birth length. In addition, the basic laboratory parameters in interrogated pregnant women were also studied: leukocytes, erythrocytes, haemoglobin, hematocrit, CRP, fibrinogen, D-dimer, platelets, AST, ALT, LDH, urea, creatinine, urate, total protein and albumin. Not only we calculated middle values, we also compared groups to each other and analysed differences where we have noticed them.
Results: It is not found statistically significant difference between groups according to age, gestational age and pregnancy. Statistically, significant difference was between groups according to parity. The pregnant women from PE group had the lowest number of deliveries. Statistically significant difference was between groups with body mass index (BMI). The pregnant women from PE groups had the maximum value of BMI. Statistically significant difference was also present between groups according to values in systolic and diastolic blood pressure. The pregnant women with PE had the maximum values, then something lower values had pregnant women with HELLP syndrome and the minimum value in control groups. Furthermore, statistically significant difference was found in urine’s protein values. The maximum values were presented in pregnant women with PE, the ones with HELLP syndrome had something lower values and the minimum value had control groups. In relation to control groups, the pregnant women with PE and HELLP syndrome had statistically significant intrauterine growth restriction (IUGR). Moreover, the statistically significant increase of leukocytes was presented in HELLP syndrome in relation to PE groups and control groups. Erythrocytes, haemoglobin and haematocrit are in statistically lower values in pregnant women with HELLP syndrome then in pregnant women with PE and in control groups. Only in the relation to pregnant women with HELLP syndrome CRP has statistically significant higher values in contrast to ones with PE. Pregnant women with HELLP syndrome have significantly lower values of fibrinogen and platelets than those who have PE and those in control groups, while the values of D-dimer are significantly higher in the group of pregnant women with HELLP syndrome than in those with PE and those in control groups. In relation to those with PE and in control groups the values of ALT and AST are statistically and significantly higher in pregnant women with HELLP syndrome. The same thing is with LDH values. The values of urea, creatinine, total proteins and albumins did not show statistically significant difference between groups. The values of urate are statistically and significantly higher in pregnant women with HELLP syndrome in relation to those in PE and in control groups, and in pregnant women with PE in relation to control groups.
Conclusion: Preeclampsia represents common and important public health problem. With proper prenatal care we could recognize on time and take better care of pregnant women with PE and HELLP syndrome. Pregnancy itself is followed by certain physiological changes in laboratory tests of pregnant women compared to non-pregnant women. Still, pregnant women with PE and HELLP syndrome have more expressed pathological changes of serum laboratory parameters. From a larger set of searches which are done upon receipt of pregnant women with suspected PE and HELLP syndrome, we might be able to extract only some of them in the future, such as: leukocytes, CRP, erythrocytes, haemoglobin, haematocrit, platelets, fibrinogen, AST, ALT, LDH and urate which have high statistical significance and are also cheaper, faster and easier for initial analysis. |
