[Serum soluble Endoglin, plasma endothelin-1 and coagulation function in early onset severe preeclampsia with organ dysfunction].

OBJECTIVE: To investigate the expression levels of serum soluble Endoglin (sEng), plasma endothelin-1 (ET-1) and coagulation function in patients suffering from early onset severe preeclampsia with organ dysfunction, and to analyze the clinical significance.

METHODS: Forty-nine early onset severe preeclampsia patients were enrolled in the study group, including 26 cases without organ dysfunction (study group I) and 23 cases with organ dysfunction (study group II). The control group included 30 cases of health pregnant women during the same period of gestation. The serum levels of sEng and plasma ET-1 were analyzed with enzyme-linked immunosorbent assay (ELISA), coagulation function was determined at the same time, and the relationship between the change in levels of sEng, ET-1, coagulation function and organ function, and also outcome of perinatal infants.

RESULTS: (1) The levels of sEng, ET-1, fibrinogen (Fib) and mean platelet volume (MPV) of the study group I and II were significantly higher compared with control group (sEng, microg/L: 10.96+/-3.21, 14.17+/-4.02 vs. 7.49+/-2.73; ET-1, microg/L: 41.54+/-10.37, 65.91+/-12.46 vs. 24.56+/-6.26; Fib, g/L: 4.41+/-1.02, 5.35+/-1.17 vs. 3.69+/-0.82; MPV, fl: 11.71+/-1.21, 13.89+/-1.76 vs. 11.03+/-0.82, all P<0.05), and prothrombin time (PT), activated partial thromboplastin time (APTT) and platelet (PLT) were significantly lower compared with control group (PT, s: 10.73+/-1.82, 8.37+/-1.51 vs. 12.95+/-1.91; APTT, s: 26.14+/-4.32, 22.69+/-3.77 vs. 30.25+/-4.71; PLT, x10(9)/L: 164.17+/-50.67, 136.43+/-51.21 vs. 201.63+/-59.83, all P<0.05). There were also statistical significances in all the values between study group I and II (all P<0.05). (2) There was positive correlation between the sEng level and systolic pressure, diastolic pressure, Fib, urine protein of 24 hours, serum creatinine (SCr); there was negative correlation between the sEng level and albumin (Alb) content, PT, estriol/creatinine (E/C) of 12-hour urine, fetal birth weight (all P<0.01). There was positive correlation between the level of ET-1 and the systolic pressure, diastolic pressure, Fib, urine protein of 24 hours, SCr, or alanine aminotransferase (ALT); there was negative correlation between the level of ET-1 and Alb, PT, E/C of 12-hour urine, or fetal birth weight (P<0.05 or P<0.01). (3)In the study group, the occurrence rate of the heart, kidney and lung dysfunction, placental abruption and perinatal death of infants increased (69.23% vs. 11.11%, 38.46% vs. 2.78%, 38.46% vs. 2.78%, 46.15% vs. 2.78%, 53.85% vs. 2.78%, all P<0.01) when the content of sEng>or=16 microg/L compared with sEng<16 microg/L; the occurrence rate of heart, kidney, liver and lung dysfunction, placental abruption and perinatal death of infants increased (64.28% vs. 11.43%, 35.71% vs. 2.86%, 28.57% vs. 5.71%, 28.57% vs. 5.71%, 35.71% vs. 5.71%, 42.86% vs. 5.71%, all P<0.01) when the level of ET-1>or=70 microg/L compared with ET-1<70 microg/L; the occurrence rate of multiple organ dysfunction syndrome was 90% (9/10) when PT<7 s, APTT<20 s and PLT<100x10(9)/L.

CONCLUSION: The elevation of levels of serum sEng, plasma ET-1 and coagulation abnormality may contribute to the pathogenesis of the organ dysfunction in early onset severe preeclampsia, and the detection of the above-mentioned indexes has important clinical value.