Ispitivanje značaja markera hiperkoagulabilnosti i globalnih hemostatskih testova u trudnoći komplikovanoj preeklampsijom

Abstract

Preeklampsija je multisistemski poremećaj koji se javlja kao komplikacija trudnoće i predstavlja jedan od vodećih uzroka mortaliteta i morbiditeta majki, ali i njihovog potomstva. Smatra se da preeklampsija nastaje kao posledica poremećaja u ranom razvoju placente koji dovodi do aktivacije maternalnog vaskularnog endotela što rezultuje generalizovanom vazokonstrikcijom, značajnim metaboličkim promenama, disfunkcijom endotela, pojačanim inflamatornim odgovorom i aktivacijom koagulacije. TakoĎe, dokazano je da pojava preeklampsije u trudnoći ukazuje na postojanje nepovoljnog kardio-metaboličkog profila ţene, te je u novijim vodičima preeklampsija uvrštena u dugoročne faktore rizika za razvoj kardiovaskularnih bolesti (KVB). Pored toga, preeklampsija i KVB imaju zajedničke faktore rizika, a oba poremećaja su okarakterisana i zajedničkim patofiziološkim promenama. Klinički simptomi preeklampsije, hipertenzija i proteinurija, ispoljavaju se nakon 20. nedelje gestacije, mada dijagnoza preeklampsije moţe da se postavi i u odsustvu proteinurije ukoliko je novonastala hipertenzija udruţena sa pojavom trombocitopenije, poremećene funkcije jetre, novorazvijene bubreţne insuficijencije, plućnog edema ili novonastalih vizuelnih odnosno cerebralnih poremećaja, te uteroplacentalnog poremećaja koji rezultuje zastojem u rastu ploda. S obzirom da je hiperkoagulabilno stanje u preeklampsiji dodatno pojačano u odnosu na normalnu trudnoću cilj ove studije je bio da se ispita korisnost globalnih testova hemostaze, endogenog trombinskog potencijala i ukupnog hemostatskog potencijala, u proceni poremećaja hemostaze u preeklampsiji, pre i nakon poroĎaja, kao i da se utvrdi povezanost ispitivanih parametara sa ishodima preeklamptične trudnoće. Analizirane su takoĎe i karakteristike fibrinskih ugrušaka u normalnoj i preeklamptičnoj trudnoći. Pored toga, odreĎivani su različiti fenotipovi ekstracelularnih vezikula i analizirana je njihova povezanost sa ispitivanim hemostatskim parametrima. U studiju je uključeno 46 trudnica sa preeklampsijom i 80 zdravih trudnica...

Pre-eclampsia is a multisystem disorder that occurs as a complication of pregnancy and is one of the leading causes of maternal mortality and morbidity, as well as of their offspring. The major cause of pre-eclampsia is considered to be a defect in early placental development leading to maternal vascular endothelial activation which results in generalized vasoconstriction, significant metabolic changes, endothelial dysfunction, enhanced inflammatory response, and coagulation activation. Also, it has been proven that the occurrence of pre-eclampsia in pregnancy indicates the existence of an unfavourable cardio- metabolic profile in women, and recent guidelines include pre-eclampsia as a long-term risk factor for the development of cardiovascular disease (CVD). Moreover, pre-eclampsia and CVD share common risk factors, and both disorders are characterized by common pathophysiological changes. Clinical symptoms of preeclampsia, hypertension and proteinuria, can be seen after 20 weeks of gestation, although the diagnosis of pre-eclampsia can be made in the absence of proteinuria if the new-onset hypertension is associated with thrombocytopenia, impaired liver function, new-onset renal failure, pulmonary oedema or new-onset visual or cerebral disorders, and uteroplacental disorder that results in fetal growth retardation. Bearing in mind that the hypercoagulable state in pre-eclampsia is further enhanced compared to normal pregnancy, the aim of this study was to evaluate the usefulness of global haemostatic assays, endogenous thrombin potential and overall haemostatic potential in the assessment of the haemostatic disorders in pre-eclampsia before and after delivery and to analyse the results of these assays in relation to the outcomes of preeclamptic pregnancy. The characteristics of fibrin clots in normal and preeclamptic pregnancies were also analyzed. Furthermore, different phenotypes of extracellular vesicles were determined and their association with the investigated hemostatic parameters was analyzed. The study involved 46 pregnant women with pre-eclampsia and 80 healthy pregnant women...