الفهرس 
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Abstract
e-eclampsia is a potentially serious condition that still
accounts for significant morbidity and mortality for the
mother and the neonate, complicating 5-7% of all pregnancies
and exposing them to a 3- to 25-fold increased risk of severe
obstetric complications. Although, the pathogenesis is not fully
understood, it is now widely accepted that vascular endothelial
dysfunction is the most astonishing and the principal event in
the pathophysiology of the disease.
Researchers investigated the fact that preeclampsia is
associated with endothelial dysfunction, a hypercoagulable
state, metabolic abnormalities, an inflammatory response and
atherosclerosis. The etiology of these conditions remains
elusive and multiple factors are implicated in pathogenesis of
pre-eclampsia among these mechanisms, insulin resistance.
Resistin is adipose-specific secreted hormone, which
belongs to the family of cysteine-rich, c-terminal proteins. It is
a potent regulator of glucose homeostasis that is thought to
oppose the action of insulin in peripheral tissues; it impairs
glucose intake by adipocytes, increases plasma glucose
concentration, and thus decreases insulin. Resistin is expressed
in the human placenta and its serum level is enhanced in the
third trimester of pregnancy; suggesting its pivotal role in the
state of insulin resistance during pregnancy. Recent studies
P
Summary and Conclusion
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suggest resistin may play an important role in the pathogenesis
of pre-eclampsia through their role in low-grade systemic
inflammation, atherosclerosis, and insulin resistance. Therefore,
it is reasonable to suppose that resistin may directly or
indirectly influence the function of placental endothelial cells.
In this regard, this study aimed to investigate the clinical
utility of maternal serum resistin in women with pre-eclampsia
compared to those in normal pregnant women and normal nonpregnant
women, and to investigate the potential role of resistin
as a mediator of insulin resistance.
This study was conducted on sixety (60) pre-eclamptic
patients. Thirty (30) patients with mild pre-eclampsia and thirty
(30) patients with severe pre-eclampsia. In addition to fifteen
(15) healthy pregnant controls and fifteen (15) healthy nonpregnant
females.
All the studied individuals were subjected to full history
taking and complete clinical examination. Blood samples were
collected for determination of ALT, AST, RBS, creatinine,
CBC, FBG, fasting insulin and serum resistin, while 24 hours
urine samples were collected for determination of total urinary
proteins. Assay of serum resistin and serum fasting insulin was
carried out using an enzyme linked immunosorbent assay
technique.
Summary and Conclusion
155
The results of the present study revealed that pregnant
controls had significantly higher serum levels of resistin and
HOMA -IR when compared to non pregnant controls. Our
study also revealed a highly significant increase in serum levels
of both resistin and HOMAIR in pre-eclamptic women when
compared to their matched controls.
As regards the relation of resistin and HOMA-IR to the
severity of pre-eclampsia, our study showed a statistically
significant increase of resistin and HOMA-IR levels in severe
pre-eclampsia in comparsion to mild pre-eclampsia. Moreover,
significant positive correlation was also found between both
resistin and HOMA –IR and both SBP and DBP, which are
considered among the indices of severity of pre-eclampsia.
Recevier operating characteristic (ROC) curve analysis
was applied to assess the diagnostic utility of resistin and
HOMA -IR for discriminating severe pre-eclamptic patients
from those with mild pre-eclampsia. It was found that the best
cutoff value of resistin was 17ng/mL. This had a diagnostic
sensitivity of 96.7%, specificity 70% positive predictive value
76.30% and negative predictive value 95.50%.. The best
diagnostic cut off level for HOMA-IR was 3.7 which had a
diagnostic sensitivity of 93 %, specificity 40 % positive
predictive value 60.90% and negative predictive value 85.70%..
In addition, the diagnostic performance of resistin and
HOMA-IR in pre-eclamptic patients versus healthy pregnant
Summary and Conclusion
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subjects to assess their utility as early indicators of preeclampsia..
The best diagnostic cut off level for resistin was 10
ng/mL. This had a diagnostic sensitivity of 88.33 %, specificity
96.67 %, positive predictive value 98.1% and negative
predictive value 80.6%. The best diagnostic cut off level for
HOMA-IR was 2.05. This had a diagnostic sensitivity of 98.33
%, specificity 86.67 % positive predictive value 93.7% and
negative predictive value 96.3%.