Chavarría Olarte M E, González Gleason A, Lara González A L, Sojo Aranda I, García Paleta Y, Vital Reyes V S, Reyes Fuentes A
Unidad de Investigación Médica en Medicina Reproductiva, Hospital de Ginecología y Obstetricia 4 Luis Castelazo Ayala, IMSS, México D.F.
Ginecol Obstet Mex. 2000 Sep;68:385-93.
It has been demonstrated that the concentrations of molecules related to endothelial cell dysfunction, coagulation and vasoconstriction are altered in preeclamptic patients, but they have not been evaluated in their relationship with the severity of preeclampsia.
To determine the relationship between the plasmatic concentrations of fibronectin ED1+, antithrombin III, prostacyclin and thromboxane, and the severity of preeclampsia.
Peripheral blood was collected from 215 women in the third trimester of pregnancy, admitted to the Luis Castelazo Ayala Gynecology and Obstetrics Hospital with mild preeclampsia (n = 103), severe preeclampsia (n = 71), HELLP syndrome (n = 25) or eclampsia (n = 16). Plasma aliquots were stored at -70 degrees C until analysis. Fibronectin ED1+ was measured by ELISA; antithrombin III activity was determined using an automated amidolytic technique, and the concentrations of the stable metabolites 6-keto-prostagiandin F1a and thromboxane B2 were measured by RIA. Statistical analysis included ANOVA and logistic regression.
Maternal age was similar in all participants. Prematurity and low birth weight were present in the patients with severe preeclampsia, HELLP and eclampsia. The values for fibronectin were similar among the 4 groups of patients. Antithrombin III activity was significantly lower in the patients with HELLP. In patients with severe preeclampsia and HELLP syndrome, prostacyclin (Pc) and thromboxane (Tbx) concentrations were significantly higher, and the Pc/Tbx ratio was lower than in patients with mild preeclampsia. Those patients who had the highest thromboxane levels and the lowest Pc/Tbx ratio had a higher chance to develop severe preeclampsia or HELLP (5 times), as well as to have premature babies (12 times) than patients with mild preeclampsia.
Our study demonstrates relationships among antithrombin III activity, prostacyclin and thromboxane concentrations, and the severity of preeclampsia. These compounds were significantly more altered in patients with HELLP syndrome, probably due to a higher organic and vascular dysfunction. Plasma determination of these compounds may be valuable as a tool in the screening of preeclampsia, and as an indicator of severity of the disease.
已证实,子痫前期患者体内与内皮细胞功能障碍、凝血和血管收缩相关的分子浓度发生了改变,但尚未对它们与子痫前期严重程度的关系进行评估。
确定纤连蛋白ED1+、抗凝血酶III、前列环素和血栓素的血浆浓度与子痫前期严重程度之间的关系。
收集了215名妊娠晚期妇女的外周血,这些妇女因轻度子痫前期(n = 103)、重度子痫前期(n = 71)、HELLP综合征(n = 25)或子痫(n = 16)入住路易斯·卡斯特拉佐·阿亚拉妇产科医院。血浆样本储存在-70℃直至分析。通过ELISA法检测纤连蛋白ED1+;使用自动酰胺水解技术测定抗凝血酶III活性,通过放射免疫分析法测定稳定代谢产物6-酮-前列腺素F1a和血栓素B2的浓度。统计分析包括方差分析和逻辑回归。
所有参与者的产妇年龄相似。重度子痫前期、HELLP综合征和子痫患者存在早产和低出生体重情况。4组患者的纤连蛋白值相似。HELLP综合征患者的抗凝血酶III活性显著降低。在重度子痫前期和HELLP综合征患者中,前列环素(Pc)和血栓素(Tbx)浓度显著升高,且Pc/Tbx比值低于轻度子痫前期患者。与轻度子痫前期患者相比,血栓素水平最高且Pc/Tbx比值最低的患者发生重度子痫前期或HELLP综合征(5倍)以及早产(12倍)的几率更高。
我们的研究证明了抗凝血酶III活性、前列环素和血栓素浓度与子痫前期严重程度之间的关系。这些化合物在HELLP综合征患者中变化更为显著,可能是由于更高的器官和血管功能障碍。血浆中这些化合物的测定作为子痫前期筛查工具以及疾病严重程度指标可能具有重要价值。