Serum Immunoglobulins (IgG, IgA, IgM) levels in Preeclampsia and Eclampsia Pregnancies

摘要

Bacground: Preeclampsia is the most common pregnancy-specific complication. It is thought to be associated with modulation of immune response. Objective: The aim of this study was to investigate the serum levels of immunoglobulins-IgG, IgA and IgM in pre-eclampsia and eclampsia, and to examine the influence of the immunoglobulins with pre-eclampsia and its complication eclampsia, if any. Methods: The study was conducted among fortythree subjects consisting of seventeen pre-eclampsia patients, eleven eclampsia patients and fifteen healthy normotensisve pregnants of singleton gestations in their third trimester. Serum immunoglobulin levels were analyzed by solid phase indirect ELISA method. Results: It was shown that serum IgG concentrations were 7.95±0.69g/L, 7.66±0.46g/L and 7.10±0.61g/L; IgA concentrations were 4.07±0.32g/L, 4.10±0.32g/L and 3.65±0.32g/L; and IgM concentrations were 2.01±0.21g/L, 2.92±0.29g/L and 2.16±0.16g/L in pre-eclampsia, eclampsia and normotensive pregnant respectively. There were no significant change in IgG and IgA between pre-eclampsia and eclampsia, but IgM level was found to be significantly higher in eclampsia than that in pre-eclampsia (t=7.87, p=0.0001). Except systolic blood pressure with IgG (r=0.689, p=0.04) and to some extent with IgA (r=-0.637, p=0.065), gestational age (r= -0.890, p=0.0001) and proteinuria (r=0.747, p= 0.008) with IgM; none of the maternal characteristics is associated with the serum immunoglobulin concentration in pre-eclampsia or eclampsia. Conclusion: It is revealed that serum immunoglobulins levels are elevated with pre-eclampsia and its complication eclampsia. Introduction Preeclampsia is the most common pregnancy-specific complication that still ranks as one of obstetrics major problems. It is a placenta dependent pregnancy disorder. Preeclampsia is associated with modulation of immune response and defective trophoblast invasion (1). Syndrome of preeclampsia is described as excessive maternal inflammatory responses, perhaps directed against foreign fetal antigens that induce a chain of events including surface trophoblast invasion, defective spiral artery remodeling, placental infarction and release of pro-inflammatory cytokines and placental fragments in the systemic circulation. Currently preeclampsia, consequently eclampsia are suggested to be caused by changes in immunity. Therefore, in addition to treating hypertension in preeclampsia, attempts of modifying immune responses may be a future treatment modality. There have been several observations on modulation of immune responses in pregnancy (2,3) and preeclampsia (1,4-9), most of which documented inflection of lymphocytes and cytokines. Report on immunoglobulin status is rare. We report here the serum IgG, IgA and IgM levels in preeclampsia and eclampsia patients. Materials And Methods Study population. It was a cross sectional case control study and was conducted prospectively in Sir Salimullah Medical College and Hospital, Dhaka. The study included 17 preeclampsia patient, 11 eclampsia patient and 15 nonhypertensive pregnant women (as controls). They are mostly from the middle class and lower class society. All the patients had have pregnancy within 25 to 40 gestational weeks and had primi to multi gravida. Though they were from middle class society, they are aware of taking proper food and antenatal care during pregnancy. Most of them were hypertensive and had have convulsion once or more. A structured questionnaire was developed to collect the maternal clinical characteristics. Ethical permission was taken from the head of the department of obstetrics and gynecology, Sir Salimullah Medical College and Hospital. Analysis of Immunoglobulins. A 5mL venous blood sample was collected from antecubital vein of each of the case and control subjects. The blood sample was kept undisturbed for at least 60 minutes and was then centrifuged at 3000rpm for 10 minutes. Serum thus extracted was stored at -20oC for analysis