Změny homeostázy těhotných po asistované reprodukční technologii asociované s preeklampsii

Stáhnout PDF English version

Autoři: V. Kaminskyi ¹; O. Zhdanovych ¹; T. Kolomiichenko ¹; S. Kornienko ²; T. Anoshina ¹; Obstetrics Of Department ¹; Gynecology; Reproductology; Education National Medical Academy Of Postgraduate Shupyk; Kyiv; Ukraine; YV. Voronenko Rector; Md, Dr.Sc.; Professor Full; Ukraine Of The National Academy Of Medical Sciences Of Academician; Science State Prize Winner In Ukraine; Technology; Scientist Honoured; Ukraine Of Technologist
Působiště autorů: Odessa national medical university, Ukraine, rector V. M. Zaporozhan, Chairman of the Academic Council of the University, Academician of the NAMS of Ukraine, Doctor of Medical Sciences, Professor ²
Vyšlo v časopise: Ceska Gynekol 2020; 85(6): 396-402
Kategorie: Prospektivní studie

Souhrn

Cíl: Stanovit markery vnitřního prostředí spojené s preeklampsií u těhotné ženy po asistované reprodukci k objasnění možných mechanismů a faktorů preeklampsie.

Typ studie: Prospektivní studie.

Název a sídlo pracoviště: Klinika porodnictví, gynekologie a reprodukční medicíny, Národní medicinská akademie, Kyjev, Ukrajina.

Metodika: Studie zahrnovala 150 těhotných žen po asistované reprodukci: 48 žen, u kterých se rozvinula preeklampsie (skupina 1), a 102 žen, u kterých se preeklampsie nerozvinula (skupina 2). Měřeny byly: jaterní enzymy – alaninaminotransferáza (ALT) a aspartátaminotransferáza (AST), markery lipidového metabolismu – celkový cholesterol (TC), lipoproteiny s vysokou hustotou (HDL-C), lipoproteiny s nízkou hustotou (LDL-C) a lipoproteiny s velmi nízkou hustotou (VLDL-C), aterogenní index (AI), triacylglyceroly (TG), koncentrace 25-hydroxy-vitaminu D, cytokíny - interleukin-1, -2, -6, -8, -10 (IL-1, IL-2,, IL-6, IL-8, IL-10), tumor necrosis faktor (TNF), počet trombocytů, jejich schopnost agregace, hodnoty fibrinogenu, aktivovaný parciální trombinový čas (aPTT), solubilní fibrinové monomery (SFMC), D-dimery, von Willebrandův faktor (vWF). Na vyhodnocení byl použit Studentův t-test.

Výsledky: U žen s preeklampsii byly elevované jaterní enzymy a lipidogram (TG, LDL, LDL, AI). Hodnoty vitaminu D byly u žen s preeklampsii nižší (25,92±4,76 vs. 38,42±5,12 ng/mL, p <0,05). Mezi jednotlivými skupinami jsme pozorovali rozdíl v hodnotách IL-1 (8,9±0,62 vs. 6,4±0,60 pg/mL, p <0,05), IL-8 (85,7±5,38 vs. 72,8±5,72 pg/mL, p <0,05) a IL-10 (2,3±0,81 vs. 4,7±0,27 pg/mL, p <0,05). U žen s preeklampsií byla zvýšená agregace trombocytů, relativní trombocytopenie, vyšší hodnoty fibrinogenu, prolongovaný aPTT, vyšší D-dimery (328,1±23,6 vs. 186,2±15,4 ng/mL, p <0,05), a von Willebrandův faktor (1,48 ± 0,21 vs. 0,76 ± 0,27 IU/mL, p <0,05).

Závěr: Preeklampsie se v těhotenství po asistované reprodukci rozvine dřív, pokud v prvním trimestru existují proaterogenní poruchy metabolismu lipidů, nedostatek vitaminu D, zhoršená zánětlivá odpověď, protrombotické změny v systému hemostázy s poškozením endotelu. Takové změny mohou být prognostickými faktory preeklampsie.

Klíčová slova:

technologie asistované reprodukce – preeklampsie – jaterní lipidový metabolismus – vitamín D – interleukin – homeostáza

Zdroje

1. Agarwal, S., Kovilam, O., Agrawal, DK. Vitamin D and its impact on maternal-fetal outcomes in pregnancy: A critical review. Crit Rev Food Sci Nutr, 2018, 58(5), p. 755–769.

2. Aggarwal, R., Jain, AK., Mittal, P., et al. Association of pro- and anti-inflammatory cytokines in preeclampsia. J Clin Lab Anal, 33(4), e22834.

3. Ahmed, A., Rezai, H., Broadway-Stringer, S. Evidence-based revised view of the pathophysiology of preeclampsia. Adv Exp Med Biol, 2017, 956, p. 355–374.

4. Ballesta-Castillejos, A., Gomez-Salgado, J., Rodriguez-Almagro, J., et al. Obstetric and perinatal complications associated with assisted reproductive treatment in Spain. J Assist Reprod Genet, 2019, 36(12), p. 2435–2445.

5. Boeldt, D., Bird, I. Vascular adaptation in pregnancy and endothelial dysfunction in preeclampsia, J Endocrinol, 2017, 232(1), R27–R44.

6. Bokslag, A., van Weissenbruch, M., Mol, BW., de Groot, CJ. Preeclampsia; short and long-term consequences for mother and neonate. Early Hum Dev, 2016, 102, p. 47–50.

7. Cavoretto, P., Candiani, M., Giorgione, V., et al. Risk of spontaneous preterm birth in singleton pregnancies conceived after IVF/ICSI treatment: meta-analysis of cohort studies. Ultrasound Obstet Gynecol, 2018, 51(1), p. 43–53.

8. Cyprian, F., Lefkou, E., Varoudi, K., Girardi, G. Immunomodulatory Effects of Vitamin D in Pregnancy and Beyond. Front Immunol, 2019, 10, p. 2739.

9. De Geyter, C., Calhaz-Jorge, C., Kupka, MS., et al. ART in Europe, 2014: results generated from European registries by ESHRE. Hum Reprod, 2018, 33(9), p. 1586–1601.

10. Eremkina, AK., Mokrysheva, NG., Pigarova, EA., Mirnaya, SS. Vitamin D: effects on pregnancy, maternal, fetal and postnatal outcomes. Ter Arkh, 2018, 90(10), p. 115–127.

11. Filipek, A., Jurewicz, E. Preeclampsia – a disease of pregnant women. Postepy Biochem, 2018, 64(4), p. 232–229.

12. Giorgione, V., Parazzini, F., Fesslova, V., et al. Congenital heart defects in IVF/ICSI pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol, 2018, 51(1), p. 33–42.

13. Gris, JC., Bouvier, S., Cochery-Nouvellon, É., et al. The role of haemostasis in placenta-mediated complications. Thromb Res, 2019, 181 (l), p. S10–S14.

14. Hoorsan, H., Mirmiran, P., Chaichian, S., et al. congenital malformations in infants of mothers undergoing assisted reproductive technologies: a systematic review and meta-analysis study. J Prev Med Public Health, 2017, 50(6), p. 347–360.

15. Kaminskyi, V., Ventskovskaia, I., Zhdanovych, O., et al. Peculiarities of psychoemotional status of pregnant women with perinatal losses in the history psychiatry psychotherapy and clinical psychology, 2020, 11 (1), p. 66–74.

16. Kaminskyi, VV., Zhdanovych, OI., Vorobey, LI., et al. Perinatal losses in anamnesis as a factor of fetus adaptation damage. Reprod Endocrinol (Ukraine), 2019, 47(3), p. 48–52.

17. Kawwass, JF, Badell, ML. Maternal and fetal risk associated with assisted reproductive technology. Obstet Gynecol, 2018, 132(3), p. 763–772.

18. Laššáková, S., Korabečná, M. New potential biomarkers for preeclampsia prediction. Čes Gynek, 2018, 83(6), p. 458–463.

19. Lattová, V., Dostál, J., Vodička, J., Procházka, M. The risk of thromboembolism in relation to in vitro fertilization. Čes Gynek. 2019, 84(3), p. 229–232.

20. Levente, T., Szilárd-Leó, K., Lujza-Katalin, B., et al. The prognostic role of thrombophilia in the treatment of infertility. Bulletin Med Sci, 2018, 91(1), p. 42–49.

21. Mirzakhani, H., Litonjua, AA., McElrath, TF., et al. Early pregnancy vitamin D status and risk of preeclampsia. J Clin Invest, 2016, 126(12), p. 4702–4715.

22. Neville, G., Martyn, F., Kilbane, M., et al. Vitamin D status and fertility outcomes during winter among couples undergoing in vitro fertilization/intracytoplasmic sperm injection. Int J Gynaecol Obstet, 2016, 135(2), p. 172–176.

23. Niederberger, C., Pellicer, A., Cohen, J., et al. Forty years of IVF. Fertil Steril, 2018, 110(2), p. 185–324.

24. Okby, R., Harlev, A., Sacks, KN., et al. Preeclampsia acts differently in in vitro fertilization versus spontaneous twins. Arch Gynecol Obstet, 2018, 297(3), p. 653–658.

25. Rana, S., Lemoine, E., Granger, JP., Karumanchi, SA. Preeclampsia: pathophysiology, challenges, and perspectives. Circ Res, 2019, 124(7), p. 1094–1112.

26. Roubalová, L., Vojtěch, J., Feyereisl, J., et al. First-trimester screening for preeclampsia. Čes Gynek, 2019, 84(5), p. 361–370.

27. Saraf, R., Morton, SM., Camargo, CAJr., Grant, CC. Global summary of maternal and newborn vitamin D status – a systematic review. Matern. Child Nutr, 2016, 12(4), p. 647–668.

28. Serrano-Díaz, NC., Gamboa-Delgado, EM., Domínguez-Urrego, CL., et al. Vitamin D and risk of preeclampsia: A systematic review and meta-analysis. Biomedica, 2018, 38(1), p. 43–53.

29. Siddiqui, IA. Maternal serum lipids in women with pre-eclampsia. Ann Med Health Sci Res, 2014, 4(4), p. 638–641.

30. Sites, CK., Wilson, D., Barsky, M., et al. Embryo cryopreservation and preeclampsia risk. Fertil Steri., 2017, 108(5), p. 784–790.

31. Sullivan-Pyke, CS., Senapati, S., Mainigi, MA., Barnhart, KT. In vitro fertilization and adverse obstetric and perinatal outcomes. Semin Perinatol, 2017, 41(6), p. 345–353.

32. Sun, T., Lee, B., Kinchen, J., et al. Differences in first-trimester maternal metabolomic profiles in pregnancies conceived from fertility treatments. J Clin Endocrinol Metab, 2019, 104(4), p. 1005–1019.

33. Sunderam, S., Kissin, DM., Crawfordë, SB., et al. Assisted reproductive technology surveillance – United States, 2015. MMWR Surveill Sum,. 2018, 67(3), p. 1–28.

34. Szpera-Gozdziewicz, A., Gozdziewicz, T., Boruczkowski, M., et al. Relationship between the von Willebrand factor plasma concentration and ultrasonographic doppler findings in pregnancies complicated by hypertensive disorders: a pilot study. Gynecol Obstet Invest, 2018, 83(3), p. 252–258.

35. Taylor, BD., Robert, B., Ness, RB., et al. First and second trimester immune biomarkers in preeclamptic and normotensive women. Pregnancy Hypertens, 2016, 6(4), p. 388–393.

36. Zhao, J., Huang, X., Xu, B., et al. Whether vitamin D was associated with clinical outcome after IVF/ICSI: a systematic review and meta-analysis. Reprod Biol Endocrinol, 2018, 16(1), p. 13.

37. Zhdanovych, OI., Vorobey, LI., Anoshina, TN., Kolomiichenko, TV. Perinatal consequences of adaptation disorder with burdened obstetric history. World Med Biol, 2020, 1(71), p. 044–049.