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

Abstract

Preeklampsija je multisistemski poremećaj koji se javlja kao komplikacija trudnoće ipredstavlja jedan od vodećih uzroka mortaliteta i morbiditeta majki, ali i njihovog potomstva.Smatra se da preeklampsija nastaje kao posledica poremećaja u ranom razvoju placente kojidovodi do aktivacije maternalnog vaskularnog endotela što rezultuje generalizovanomvazokonstrikcijom, značajnim metaboličkim promenama, disfunkcijom endotela, pojačaniminflamatornim odgovorom i aktivacijom koagulacije. TakoĎe, dokazano je da pojavapreeklampsije u trudnoći ukazuje na postojanje nepovoljnog kardio-metaboličkog profilaţene, te je u novijim vodičima preeklampsija uvrštena u dugoročne faktore rizika za razvojkardiovaskularnih bolesti (KVB). Pored toga, preeklampsija i KVB imaju zajedničke faktorerizika, a oba poremećaja su okarakterisana i zajedničkim patofiziološkim promenama.Klinički simptomi preeklampsije, hipertenzija i proteinurija, ispoljavaju se nakon 20. nedeljegestacije, mada dijagnoza preeklampsije moţe da se postavi i u odsustvu proteinurije ukolikoje novonastala hipertenzija udruţena sa pojavom trombocitopenije, poremećene funkcijejetre, novorazvijene bubreţne insuficijencije, plućnog edema ili novonastalih vizuelnihodnosno cerebralnih poremećaja, te uteroplacentalnog poremećaja koji rezultuje zastojem urastu ploda.S obzirom da je hiperkoagulabilno stanje u preeklampsiji dodatno pojačano u odnosuna normalnu trudnoću cilj ove studije je bio da se ispita korisnost globalnih testovahemostaze, endogenog trombinskog potencijala i ukupnog hemostatskog potencijala, uproceni poremećaja hemostaze u preeklampsiji, pre i nakon poroĎaja, kao i da se utvrdipovezanost ispitivanih parametara sa ishodima preeklamptične trudnoće. Analizirane sutakoĎe i karakteristike fibrinskih ugrušaka u normalnoj i preeklamptičnoj trudnoći. Poredtoga, odreĎivani su različiti fenotipovi ekstracelularnih vezikula i analizirana je njihovapovezanost 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 pregnancyand is one of the leading causes of maternal mortality and morbidity, as well as of theiroffspring. The major cause of pre-eclampsia is considered to be a defect in early placentaldevelopment leading to maternal vascular endothelial activation which results in generalizedvasoconstriction, significant metabolic changes, endothelial dysfunction, enhancedinflammatory response, and coagulation activation. Also, it has been proven that theoccurrence 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 riskfactor for the development of cardiovascular disease (CVD). Moreover, pre-eclampsia andCVD share common risk factors, and both disorders are characterized by commonpathophysiological changes. Clinical symptoms of preeclampsia, hypertension andproteinuria, can be seen after 20 weeks of gestation, although the diagnosis of pre-eclampsiacan be made in the absence of proteinuria if the new-onset hypertension is associated withthrombocytopenia, impaired liver function, new-onset renal failure, pulmonary oedema ornew-onset visual or cerebral disorders, and uteroplacental disorder that results in fetal growthretardation.Bearing in mind that the hypercoagulable state in pre-eclampsia is further enhancedcompared to normal pregnancy, the aim of this study was to evaluate the usefulness of globalhaemostatic assays, endogenous thrombin potential and overall haemostatic potential in theassessment of the haemostatic disorders in pre-eclampsia before and after delivery and toanalyse the results of these assays in relation to the outcomes of preeclamptic pregnancy. Thecharacteristics of fibrin clots in normal and preeclamptic pregnancies were also analyzed.Furthermore, different phenotypes of extracellular vesicles were determined and theirassociation with the investigated hemostatic parameters was analyzed.The study involved 46 pregnant women with pre-eclampsia and 80 healthy pregnantwomen...