ABSTRACT
This study was carried out to determine the levels of proteins, bilirubin and lipid profile of pre-eclamptic patients attending Imo state specialist hospital, Umuguma. Sixty(60) subjects aged 25-40 years were recruited for the study and they were divided into two groups of thirty(30) pre-eclamptic women and thirty(30) apparently healthy pregnant women. The sample was collected using a standard clean venipuncture technique and the statistical analysis was carried out using statistical package for social sciences(SPSS). The result obtained showed a significant decrease in total protein and albumin in pre-eclampsia women with mean values of 60.02±3.07g/l and 30.67±3.3g/l when compared with apparently healthy pregnant women with mean values of 65.69±4.9g/l and 36.30±2.9g/l at P<0.05. In the bilirubin, both Total Bilirubin and Conjugated Bilirubin showed a significant increase in pre-eclamptic women with mean values of 0.7±0.15mg/dl and 0.22±0.097mg/dl when compared with the apparently healthy pregnant women with mean values 0.57±0.20mg/dl and 0.10±0.04mg/dl at P<0.05. For lipid profile, Total Cholesterol(Tc), Triglyceride(Tg) and Low Density Lipoprotein(LDL) showed a significant increase in Pre-eclamptic women with mean values of 231.34±18.59mg/dl, 162.32±25.40mg/dl and 176.65±27.26mg/dl when compared with the apparently healthy pregnant women with mean values of 201.79±16.63mg/dl, 84.47±8.69mg/dl and 54.18±4.49 mg/dl at P<0.05 while High Density Lipoprotein(HDL) shows a significant decrease in pre-eclamptic women with mean values of 44.27±4.11mg/dl when compared with the apparently healthy pregnant women with mean values of 49.50±7.25mg/dl at P<0.05.This findings shows that pre-eclampsia is associated with hypoproteinaemia, hypoalbuminaemia, hyperbilirubinaemia and hyperlipidaemia Hence could probably serve as a biochemical marker in pre-eclampsia.
TABLE OF CONTENT
Title page i
Certification ii
Dedication iii
Acknowledgement iv
Abstract v
Table of content vi
List of figures x
List of tables xi
CHAPTER ONE: INTRODUCTION
- Introduction 1
1.1 Justification 4
1.3 Aims and objective 5
CHAPTER TWO: LITERATURE REVIEW
2.1 Definition of preeclampsia 6
2.1.1 Etiology and pathophysiology of preeclampsia 6
2.1.2 Signs, symptoms and causes of preeclampsia 9
2.1.3 Risk factors for preeclampsia 10
2.1.4 Diagnosis, prevention and treatment 11
2.2 Serum proteins 13
2.2.1 Structural components and polypeptide chains
Of proteins 13
2.2.2 Structure of protein 16
2.2.3 Classification of proteins 17
2.2.4 Digestion of proteins 19
2.2.5 Absorption of proteins 20
2.2.6 Functions of proteins 20
2.2.7 Clinical significance of protein 22
2.3 Serum albumin 22
2.3.1 Functions of albumin 23
2.3.2 Clinical significance of albumin 24
2.3.3 Protein and preeclampsia 25
2.4 Bilirubin 26
2.4.1 Bilirubin metabolism 29
2.4.2 Disorders of bilirubin metabolism 32
2.4.3 Bilirubin and preeclampsia 33
2.5 Lipid 34
2.5.1 Digestion, absorption and transport of lipids 34
2.5.2 Biological functions of lipids 35
2.5.3 Classification of lipids 36
2.5.4 Serum lipid profile 37
2.5.5 Serum triglyceride 38
2.5.6 Serum total cholesterol 39
2.5.7 Lipoproteins 42
2.5.8 Metabolism of lipoproteins 44
2.5.9 Lipid profile and preeclampsia 47
CHAPTER THREE: MATERIALS AND METHODS
3.1 Study area 49
3.2 Advocacy, mobilization and pre-survey contacts 49
3.3 Study population 50
3.4 Selection criteria 51
3.5 Sample collection 52
3.6 Method of assay 53
3.6.1 Serum total protein estimation 53
3.6.2 Serum albumin estimation 55
3.6.3 Serum bilirubin estimation 56
3.6.4 Serum lipid profile estimation 59
3.7 Statistical analysis 65
CHAPTER FOUR: RESULT
4.0 Result 66
CHAPTER FIVE: DISCUSSION
5.1 Discussion 71
5.2 Conclusion 72
5.3 Recommendation for further research 73
REFERENCES 74
APPENDICES 81
CHAPTER ONE
1.0 INTRODUCTION
- Introduction
Pre-eclampsia is defined as the presence of systolic blood pressure (SBP) greater than or equal to 140mmHg and diastolic blood pressure(DBP)greater than or equal to 90mmHg (Jameil et al., 2014). Pre-eclampsia is a multisystem disorder affecting several organs and maternal systems including the vascular system, liver, kidney and brain (Steegers et al., 2010). It is a complication of pregnancy that contribute to both maternal and fetal problems.
Pre-eclampsia is also characterized by the presence of protein in urine called proteinuria. The disorder affects about 2-4% of pregnancies (Lana et al., 2004). Despite the intensive research in this area, the etiology of pre-eclampsia remains unknown. It seems to have a multifactorial cause and is also known as the “disease of theories”. There are several signs and symptoms which are associated with pre-eclampsia. Although these signs and symptoms are not usually specific for pre-eclampsia, they share almost the same signs and symptoms with pregnancy which are swelling, pitting edema, convulsion, epigastric pain (Jameil et al., 2014). The causes of pre-eclampsia maybe genetic, immune placental and other factors.
Proteins are large molecules made up of Amino acids bonded together by peptide bond (Chatterjea and Rana, 2012). All proteins have carbon, Hydrogen, oxygen, nitrogen and sulphur. These are essential in their structure. There are numerous sources of proteins like milk, egg, beans etc. There are so many classes of proteins. E.gs. of some proteins include Albumin, globulin, lipoproteins etc. In Pre-eclampsia, there are usually presence of protein in urine. Normally protein being a large molecule is not supposed to be found in urine, because of the damage of the glomeruli of the kidney in a pre-eclamptic patient, there are usually presence of protein in urine. (Neithardt et al., 2002). Therefore in a pre-eclamptic patient, there are usually decreased protein (albumin, globulin and total protein). Also because of the phenomenom of hemodilution and increased demand of the developing fetus, serum albumin decreases during all the trimesters in a pre-eclamptic patient (Harold et al., 2006).
Bilirubin is a product formed from the breakdown of hemoglobin in the Red blood cells of the liver, spleen, bone marrow and reticuloendothelial system (RES). This occurs after 120 days because red blood cells have a life span of 120 days (Nwanjo, 2006). Oxidative stress is involved in the pathogenesis of pre-eclampsia. This is as a result of increased production of oxidizing agents that is not counteracted by antioxidant. Bilirubin is a non-enzymatic antioxidant and it also helps to counteract the ROS (Reactive oxygen species) and RNS (reactive nitrogen species) produced during oxidative stress in pre-eclampsia. Therefore there are usually increased levels of Bilirubin in pre-eclampsia. This is because there is usually increased breakdown of RBC in a pre-eclamptic patient (Raijmakers et al., 2004).
Lipids are large and diverse group of naturally occurring organic compounds that are related by their solubility in non-polar organic solvents (Swapnali et al., 2011). Lipid profile is a blood test done in other to assess the status of fat metabolism in the body and its importance in heart disease. This includes measuring lipids and its derivatives called lipoproteins (HDL, LDL, TG). It is usually performed with a fasting specimen (Zhang et al., 2014). The physiological hyperlipidemia observed in healthy pregnant women is further exacerbated in pre-eclampsia (Ray et al., 2006). Pre-eclampsia is characterized by intense changes of lipid profile. According to Bayhan et al., (2005) there is an increase in TG, LDL-C and total cholesterol but a decrease in HDL-C.
- Justification
Pre-eclampsia is a pregnancy specific disorder characterized by an impaired blood perfusion of vital organs including the fetal-placental unit. The prevalence of pre-eclampsia although usually reported as 4%-8% presents some variations in the literature particularly for different populations (Sibai et al., 2015; Maynard et al., 2010). Several studies indicate that pre-eclampsia is associated with a higher incidence of newborns with low birth weight (Groom et al., 2007; Duley, 2009; Wu et al., 2009). Some neonatal complications resulting from pre-eclamptic pregnancy are described and are associated with prematurity including Jaundice, respiratory distress, apnea, seizures, hypoglycaemia and prolonged hospitalization (Duley, 2009; Wu et al., 2009).
The changes of total protein, albumin, bilirubin and lipid profile (HDL.C, LDL.C, TC and TG) are worth assessing for in pre-eclamptic patients. Moreover, there is paucity of published work on the aspect of total proteins, albumin, bilirubin and lipid profile in pre-eclamptic patients in Nigeria. However, the intensity of pre-eclampsia, socio-economic and cultural practices vary in various parts of the country. This work is expected to address the paucity of information on the molecular dynamics of pre-eclampsia and prevention with a view to provoking further research especially in the area of diagnosis, management, and prevention.
- Aim and specific objectives
- Aim
To estimate the levels of Total protein, Albumin, Bilirubin and Lipid profile in pre-eclamptic patients in Imo Specialist Hospital Umuguma,Owerri.
- Specific Objectives
- To determine the level of proteins (Total protein and albumin) in pre-eclamptic patients.
- To determine the level of bilirubin (Total and conjugated) in pre-eclamptic patients
- To determine the level of lipid profile (TG, TC, HDL-C and LDL-C) in pre-eclamptic patients
- To compare the total protein, albumin, bilirubin and lipid profile values in pre-eclamptic women with that of normal pregnancy.
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