Serum Levels Of Adipokine Chemerin And NGAL In Pre-eclampsia

ObjectiveIn this study, we have compared maternal serum chemerin and NGAL levels in preeclamptic women with or without gestational diabetes mellitus, and with those in healthy pregnant controls. To investigate the association of serum chemerin and NGAL with metabolic syndrome related phenotypes and the severity of preeclampsia, discuss their roles in the pathogenesis of preeclampsia.MethodsThis study included 192 women in the third trimester of a singleton pregnancy. There were: (1)116 newly diagnosed preeclamptic women, and they were further stratified into two subgroups: 40 subjeces complicated by PE with gestational diabetes mellitus and 76 sbujects complicated by PE without gestational diabetes mellitus according to the 75g OGTT. (2) 76 healthy pregnant women. They were recruited from the pregnant women presenting for perinatal health care at the department of Obstetrics of the Guangdong Women and Children's Hospital and Health Institute between June 2009 and December 2010. The PE group, PE with gestational diabetes mellitus group and PE without gestational diabetes mellitus group were further stratified into two subgroups (mild preeclampsia and severe preeclampsia) according to the severity of PE. All studied subjects were further stratified: normal weight group, over weight / obese group according to Body Mass Index; And all studied subjects were divided by extent of insulin resistans into HOMA-IR tertiles: the first HOMA-IR tertile, the second HOMA-IR tertile and the third HOMA-IR tertile.The maternal levels of serum chemerin and NGAL were quantified by quantitative sandwich enzyme immunoassay technique. Peripheral blood samples were collected to detect the serum chemerin and NGAL , FBG, FINS, TG, TCH, HDL-C, LDL-C, APO\A1, APO\B, FFAs, APTT, PT, Fbq, TT, AT-III, D-D, AST, ALT, BUN, UA, CRE, LDH, CK, PLT. The 24 hour urine was collected for detect the 24h-Proteinuria.The study was approved by the local hospital ethics committee, and all the women gave written informed consent before the initiation of the study and fulfill the questionare. Meanwhile blood pressure, height and body weight were measured and BMI and HOMA-IR were calculated.Results1.The serum chemerin and NGAL levels were found to be significantly increased in the women with pre-eclampsia. Preeclamptic women with gestational diabetes mellitus have highest serum chemerin and NGAL level as compared with those without GDM and healthy pregnant control group. Moreover, patients complicated by preeclampsia without GDM had the higher levels of serum chemerin and NGAL concentrations as compared with healthy pregnant control group.2.Moreover, patients with severe preeclampsia had the higher levels of serum chemerin and NGAL concentrations as compared with mild preeclampsia. The serum chemerin and NGAL levels were found to be significantly increased in the women with SPE of the group of preeclampsia without GDM as compared with MPE. The serum chemerin and NGAL concentrations were not significantly different between SPE and MPE in the PE with GDM group.3.The serum chemerin and NGAL levels were higher in over weight/obese women than those in the normal weight women.4.Chemerin and NGAL serum levels were significantly higher in the third HOMA-IR tertile as compared to the first HOMA-IR tertile.5.The FBG,HOMA-IR,FFAs,CRE levels were found to be significantly higher in the subjects complicated by PE with GDM as compared to PE without GDM, and healthy pregnant subjects. Patients with severe preeclampsia had the higher levels of FBG,TG,TCH and FFAs as compared with mild preeclampsia.6.Serum chemerin and NGAL levels significantly and positively correlated A-BMI, A-SBP, A-DBP, FBG, FINS, HOMA-IR, TG, TCH, LDL\C, APO\B, FFAs, CRE and Upro. As stepwise regression analysis showed that the serum chemerin levels significantly and positively correlated with A-SBP,A-BMI,HOMA-IR,FFAs, and the serum NGAL levels significantly and positively correlated with A-DBP,HOMA-IR,CRE,Upro.7.The diagnostic efficacy of serum chemerin levels for preeclampsia was a sensitivity of 70.6% and specificity of 71.4% at a chemerin cutoff concentration of 239.277 ng/ml. The diagnostic efficacy of serum NGAL levels for severe preeclampsia was a sensitivity of 71.6% and specificity of 66% at a NGAL cutoff concentration of 56.02 ng/ml.Conclusion1. maternal serum chemerin and NGAL levels are significantly increased in pre-eclampsia, especially in patients complicated by PE with GDM and in severe pre-eclampsia.We could hypothesize that chemerin and NGAL involved in the pathogenesis of preeclampsia.2. Serum chemerin and NGAL levels significantly correlated with the metabolic syndrome phenotypes (A-SBP,A-DBP,FBG,FINS,HOMA-IR,TG,FFAs,obesity) and with the severity of preeclampsia(CRE and Upro). These results indicated that the functions of inducing endothelial dysfunction, regulating adipogenesis, promoting insulin resistant and regulating lipid metabolism of chemerin and NGAL may contribute to the pathogenesis of pre-eclampsia.3. Chemerin has high sensitivity and specificity to diagnose preeclampsia at the chemerin cutoff concentration of 239.277 ng/ml. The results suggested that chemerin may be a valuable biomarker of pre-eclampsia.4. NGAL has high sensitivity and specificity to diagnose severe preeclampsia at the NGAL cutoff concentration of 56.02 ng/ml. The results suggested that NGAL may be a valuable biomarker of pre-eclampsia playing a role in the genesis and development of pre-eclampsia.