LOW SERUM BILIRUBIN LEVELS IN WOMEN WITH THE ANTIPHOSPHOLIPID SYNDROME.

OBJECTIVE: The aim: To investigate the relationship between serum bilirubin level and the presence of the APS in women with a history of spontaneous miscarriages. PATIENTS AND METHODS: Materials and methods: Fifty six women aged 22-38 (median 27) years with a history of spontaneous miscarriages were divided into two groups: 33 women with the APS and 23 without. Patients were tested for the presence of lupus anticoagulant, anticardiolipin, anti-ß2-glycoprotein 1, antiphospholipid antibodies and genetic thrombophilic defects. RESULTS: Results: Groups were comparable by age, blood pressure, BMI, co-morbidity (anemia, heart abnormality, thyroid disease, overweight). Median serum total bilirubin levels were 7,2 µmol/L (interquartile range [5,8-9,7]) in women with the APS and 10,5 µmol/L (interquartile range [7,5-15,1]) in control group, p=0.005. The chance of detecting a total bilirubin level of less than 8 µmol/L is 4.1 times higher in the APS patients than in the control group (OR 4,1; 95% CI 1,274-13,213). Logistic regression analysis found a statistically significant association between total bilirubin and the presence of the APS (odds ratio, 0.856; 95% CI, 0.734-0.997, p =0.046). Patients with the APS had elevated serum C-reactive protein (medians 2,3 vs 1,1 mg/L, p=0.01) and fibrinogen (medians 2,8 vs 2,5 g/L, p=0.006) levels compared with controls. Correlation analysis revealed a significant correlation between all types of bilirubin and inflammatory markers. CONCLUSION: Conclusions: All types of serum bilirubin (total, direct and indirect) are significantly reduced in women with APS, associated with higher inflammatory markers and lower levels of 25-hydroxyvitamin D, which may be the result of oxidative stress.

Correlations between lipid metabolism indices in patients with hypertension and hypothyroidism.

OBJECTIVE: Introduction: Hypertension is a major reason behind morbidity, disability and mortality. Elevated blood pressure is a huge risk factor for cardio-vascular diseases. Almost 90% of hypertension patients have internal comorbidities, in particular hypothyroidism. For now, however, the specificities of the clinical course of hypertension in hypothyroid patients are understudied and the data on lipid metabolism in patients with primary hypothyroidism and hypertension are inconclusive. The study aims at establishing the effect of the lipid metabolism indices in hypertensive patients with hypothyroidism using correlation analysis. PATIENTS AND METHODS: Materials and methods: The total of 198 patients with stage 1 and stage 2 hypertension were examined. The patients were divided into two groups based on whether they have hypothyroidism or normal thyroid function. RESULTS: Results: The study revealed that in patients with hypertension and hypothyroidism, hypercholesterolemia is associated with hypocoagulation, hyperkalaemia, decreased bilirubin levels and adrenal cortex activation. Hyperbetalipoproteinemia is linked to the reduced thyroid gland, activation of the lymphocytic component of the inflammatory response, predisposition to hypocoagulation, probable unfavourable acute stress response and development of the eccentric hypertrophy of the left ventricle myocardium. Elevated triglycerides have an effect on the progression of arterial hypertension and are associated with diastolic dysfunction of the left ventricle and hepatic dysfunction. CONCLUSION: Conclusion: The combination of hypothyroidism and hypertension is an unfavourable factor in the development and progression of dyslipidaemia, which, in its turn, can cause blood coagulation disorders, adrenal glands activation, cardiac, renal and hepatic damage, and negative adaptive responses.