Serum level of neutrophii gelatinase-associated lipocalin in preeclampsia with gestational diabetes mellitus

Abstract

Objective To investigate the relationship of serum neutrophil gelatinase associatedlipocalin (NGAL) levels among preeclamptic women with or without gestational diabetes mellitus (GDM),GDM and healthy pregnant controls. Methods This study included 263 singleton pregnant women who visited the antenatal chinics in Guangdong Women and Children's Hospital and Health Instutite Affiliated to Guangzhou Medical College from December 2009 to November 2010,77 healthy pregnant women,77 women with preeclampsia,77 women with GDM and 32 women complicated with both preeclampsia and GDM.Blood pressure,height and body weight of all subjects were measured.Peripheral blood samples were collected to detect serum NGAL,parameters of glycolipid metabolism,24-hour urine protein content,uric acid,creatinine and lactate dehydrogenase.Maternal levels of serum NGAL were quantified by enzyme-linked immunosorbent assay.Meanwhile,body mass index (BMI) and homeostasis model assessment for insulin resistance (HOMA-IR) were calculated. Data under normal distribution were analyzed with one-way ANOVA and Student's t test,and those under abnormal distribution were compared with Kruskal-Wallis H or Mann-Whitney U test. Results The preeclampsia with GDM group had higher serum NGAL level [(70.82±20.02) ng/ml] as compared with preeclampsia group [(56.17 ±18.22) ng/ml],GDM group [(43.99 ± 14.82) ng/ml] and healthy pregnant control group [(17.80±5.78) ng/ml],t=3.65,5.97,14.76,P＜0.01,respectively.The NGAL levels in preeclampsia group without GDM were higher than in GDM group (t=5.90,P＜0.01).In both the preeclampsia with and without GDM groups,NGAL levels in patients with severe preeclampsia were higher than in the mild ones [(76.44±28.06) ng/ml or(60.15±25.86) ng/ml,t=2.82,P＜0.05; (61.61±37.14) ng/ml or (46.30±13.97) ng/ml,t=4.74,P＜0.01].After adjusted by gesrational weeks and maternal age,NGAL level was positively correlated with BMI before pregnancy (r=0.335,P＜0.01),BMI after pregnancy (r=0.427,P＜0.01),systolic blood pressure (r=0.648,P＜0.01),diastolic blood pressure (r=0.664,P＜0.01),fasting blood glucose (r=0.320,P＜0.01),fasting insulin level (r=0.381,P＜0.01),HOMA-IR (r=0.399,P＜0.01),triglyceride level (r=0.405,P＜0.01),total cholesterol (r=0.145,P＜0.05),free fatty acids (r=0.335,P＜0.01),uric acid (r =0.292,P＜0.01),creatinine (r =0.226,P ＜ 0.01),and 24-hour urine protein content (r =0.436,P＜0.01),and negatively correlated with high density lipoprotein-cholesterol (r=-0.189,P =0.008).Stepwise regression analysis showed that systolic blood pressure (β =0.251,P ＜ 0.01),diastolic blood pressure (β=0.351,P＜0.01),HOMA-IR (β=0.265,P＜0.01) and 24-hour urine protein content (β=0.140,P=0.011) were independent factors of NGAL. Conclusions Serum NGAL levels increase significantly in patients with preeclampsia or GDM,and are correlated with parameters of glycolipid metabolism end endothelial dysfunction,which might play a role in the pathogenesis of preeclampsia and GDM. Key words: Pre-eclampsia;  Diabetes, gestational;  Acute-phase proteins;  Proto-oncogene proteins;  Lipocalins