Změny homeostázy těhotných po asistované reprodukční technologii asociované s preeklampsii

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Authors: 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
Authors‘ workplace: 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
Published in: Ceska Gynekol 2020; 85(6): 396-402
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Overview

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

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