Knapen M F, Mulder T P, Bisseling J G, Penders R H, Peters W H, Steegers E A
Department of Obstetrics and Gynecology, University Hospital Nijmegen, The Netherlands.
Am J Obstet Gynecol. 1998 Jan;178(1 Pt 1):161-5. doi: 10.1016/s0002-9378(98)70645-3.
Our purpose was to investigate the value of plasma glutathione S-transferase Alpha 1-1 measurements in the assessment of hepatocellular damage in hypertensive disorders of pregnancy.
Patients were recruited at the Department of Obstetrics and Gynecology of the University Hospital, Nijmegen, The Netherlands. Five groups of patients were studied: normotensive pregnancy (n = 87), pregnancy-induced hypertension (n = 48), preeclampsia (n = 79), the syndrome of hemolysis, elevated liver enzymes, and low platelets (n = 39), and serially studied normotensive pregnancy (n = 21). Blood was collected for assessment of plasma glutathione S-transferase Alpha 1-1 levels and serum alanine aminotransferase activity. Levels in hypertensive pregnancies were compared with levels in normotensive pregnancy by the Mann-Whitney U test. Patients were categorized according as to whether their values are below (normal) or above (elevated) the upper normal reference level. The difference in relative magnitude of elevation between the two factors was determined by the Wilcoxon matched-pairs signed-rank test.
Plasma levels in the longitudinally studied normotensive pregnancy group did not differ between gestational ages and were not significantly different from those of the normotensive control group. Median levels of glutathione S-transferase Alpha 1-1 and alanine aminotransferase were significantly increased (p < 0.01, p < 0.0001, respectively) in all subgroups of hypertensive pregnancies compared with normotensive pregnancies. When both levels were elevated, the relative magnitude of the increase of glutathione S-transferase Alpha 1-1 levels was significantly higher than that of alanine aminotransferase activity in preeclampsia (p < 0.01) and the syndrome of hemolysis, elevated liver enzymes, and low platelets (p < 0.0001). Almost half the patients with preeclampsia showed elevated levels of alanine aminotransferase and/or glutathione S-transferase Alpha 1-1.
Plasma glutathione S-transferase Alpha 1-1 measurements may provide a more sensitive indicator of acute hepatic damage in preeclampsia and the syndrome of hemolysis, elevated liver enzymes, and low platelets compared with the assessment of aminotransferase activity and therefore may allow earlier recognition of these syndromes. The clinical benefits of plasma measurements of glutathione S-transferase Alpha 1-1 for monitoring the hepatic condition in the management of these patients need to be elucidated in further studies.
我们的目的是研究血浆谷胱甘肽S -转移酶α1-1检测在评估妊娠高血压疾病中肝细胞损伤方面的价值。
在荷兰奈梅亨大学医院妇产科招募患者。研究了五组患者：血压正常的妊娠（n = 87）、妊娠高血压（n = 48）、先兆子痫（n = 79）、溶血、肝酶升高和血小板减少综合征（n = 39），以及进行连续研究的血压正常的妊娠（n = 21）。采集血液以评估血浆谷胱甘肽S -转移酶α1-1水平和血清丙氨酸氨基转移酶活性。通过曼-惠特尼U检验比较高血压妊娠组与血压正常妊娠组的水平。根据患者的值是低于（正常）还是高于（升高）正常参考上限进行分类。通过威尔科克森配对符号秩检验确定两个因素升高幅度的相对差异。
纵向研究的血压正常妊娠组的血浆水平在不同孕周之间无差异，且与血压正常对照组的水平无显著差异。与血压正常妊娠相比，所有高血压妊娠亚组的谷胱甘肽S -转移酶α1-1和丙氨酸氨基转移酶的中位数水平均显著升高（分别为p < 0.01，p < 0.0001）。当两种水平均升高时，在先兆子痫（p < 0.01）和溶血、肝酶升高和血小板减少综合征（p < 0.0001）中，谷胱甘肽S -转移酶α1-1水平升高的相对幅度显著高于丙氨酸氨基转移酶活性。几乎一半的先兆子痫患者显示丙氨酸氨基转移酶和/或谷胱甘肽S -转移酶α1-1水平升高。
与评估氨基转移酶活性相比，血浆谷胱甘肽S -转移酶α1-1检测可能为先兆子痫和溶血、肝酶升高和血小板减少综合征中的急性肝损伤提供更敏感的指标，因此可能有助于更早地识别这些综合征。血浆谷胱甘肽S -转移酶α1-1检测在监测这些患者肝脏状况中的临床益处需要在进一步研究中阐明。
