PLASMA GLUTATHIONE-S-TRANSFERASE-ALPHA-1-1 - A MORE SENSITIVE MARKER FOR HEPATOCELLULAR DAMAGE THAN SERUM ALANINE AMINOTRANSFERASE IN HYPERTENSIVE DISORDERS OF PREGNANCY

OBJECTIVE: Our purpose was to investigate the value of plasma glutathi one S-transferase Alpha 1-1 measurements in the assessment of hepatoce llular damage in hypertensive disorders of pregnancy. STUDY DESIGN: Pa tients were recruited at the Department of Obstetrics and Gynecology o f the University Hospital Nijmegen, The Netherlands. Five groups of pa tients were studied: normotensive pregnancy (n = 87), pregnancy-induce d hypertension (n = 48), preeclampsia (n = 79), the syndrome of hemoly sis, elevated liver enzymes, and low platelets (n = 39), and serially studied normotensive pregnancy (n = 21). Blood was collected for asses sment of plasma glutathione S-transferase Alpha 1-1 levels and serum a lanine aminotransferase activity. Levels in hypertensive pregnancies w ere compared with levels in normotensive pregnancy by the Mann-Whitney U test. Patients were categorized according as to whether their value s are below (normal) or above (elevated) the upper normal reference le vel. The difference in relative magnitude of elevation between the two factors was determined by the Wilcoxon matched-pairs signed-rank test . RESULTS: Plasma levels in the longitudinally studied normotensive pr egnancy group did not differ between gestational ages and were not sig nificantly different from those of the normotensive control group. Med ian levels of glutathione S-transferase Alpha 1-1 and alanine aminotra nsferase were significantly increased (p < 0.01, p < 0.0001, respectiv ely) in all subgroups of hypertensive pregnancies compared with normot ensive pregnancies. When both levels were elevated, the relative magni tude of the increase of glutathione S-transferase Alpha 1-1 levels was significantly higher than that of alanine aminotransferase activity i n preeclampsia (p < 0.01) and the syndrome of hemolysis, elevated live r enzymes, and low platelets (p < 0.0001). Almost half the patients wi th preeclampsia showed elevated levels of alanine aminotransferase and /or glutathione S-transferase Alpha 1-1. CONCLUSION: Plasma glutathion e S-transferase Alpha 1-1 measurements may provide a more sensitive in dicator of acute hepatic damage in preeclampsia and the syndrome of he molysis, elevated liver enzymes, and low platelets compared with the a ssessment of aminotransferase activity and therefore may allow earlier recognition of these syndromes. The clinical benefits of plasma measu rements of glutathione S-transferase Alpha 1-1 for monitoring the hepa tic condition in the management of these patients need to be elucidate d in further studies.