Sadov R I, Panova I A, Nazarov S B, Kuzmenko G N, Klycheva M M
Ivanovo Research Institute of Maternity and Childhood named after V.N. Gorodkov, 153045, Ivanovo, Russian Federation.
Klin Lab Diagn. 2020;65(5):281-288. doi: 10.18821/0869-2084-2020-65-5-281-288.
The aim of this research is the study of haemostasis of pregnant women suffering from various forms of hypertensive disorders in their III trimester of pregnancy. 165 women at 26-41 weeks of pregnancy were examined: 22 women had moderate preeclampsia, 31 had severe preeclampsia, 45 women suffered from chronic hypertension, 20 women have developed preeclampsia on the background of chronic hypertension and 47 women had no hypertensive disorders (control group). The hemostasis system has been assessed using the results of the following investigations: thromboelastography, induced platelet aggregation with ADP and adrenaline at a dosage of 1.25 and 2.5 μg/ml respectively and collagen at a dosage of 20 mg/ml, platelet ATP secretion and the average concentration of platelet components. Thromboelastography has been performed using TEG® 5000 thromboelastograph (Haemoscope Corporation, USA). The study of platelet aggregation and platelet ATP secretion has been performed at automatic aggregometer CHRONO-LOG® Model 700 (USA). The mean platelet component concentration has been measured using SIEMENS ADVIA 2120i automated hematology analyzer (Siemens Healthcare Diagnostics Inc., USA). Thromboelastogram analysis showed a decrease in the plasma hemostasis activity in all groups of women with hypertensive disorders. The functional activity of platelets of women with moderate preeclampsia and chronic arterial hypertension did not change in comparison with to the control group. The disorder of dense platelet granules degranulation and decrease in their aggregation ability have been detected in a cohort with severe preeclampsia. The decrease in adrenaline induced platelet aggregation has been noted in the group of women suffering from preeclampsia on the background of chronic arterial hypertension. Thromboelastography analysis (R, K, angle α, TMA, Cl, LY30) may be useful for the differential diagnosis of severe preeclampsia and chronic arterial hypertension. The results of the study led to the conclusion that it is advisable to use low doses of ADP and adrenaline as inducers of platelet aggregation, considering their granulocyticity and the ability to secrete ATP.
本研究的目的是对妊娠晚期患有各种形式高血压疾病的孕妇的止血情况进行研究。对165名妊娠26 - 41周的女性进行了检查：22名女性患有中度子痫前期，31名患有重度子痫前期，45名女性患有慢性高血压，20名女性在慢性高血压基础上并发子痫前期，47名女性无高血压疾病（对照组）。通过以下检查结果评估止血系统：血栓弹力图、分别用剂量为1.25μg/ml和2.5μg/ml的ADP和肾上腺素以及剂量为20mg/ml的胶原诱导血小板聚集、血小板ATP分泌和血小板成分的平均浓度。使用TEG® 5000血栓弹力图仪（美国血液镜公司）进行血栓弹力图检查。使用CHRONO - LOG® 700型自动血小板聚集仪（美国）进行血小板聚集和血小板ATP分泌的研究。使用西门子ADVIA 2120i全自动血液分析仪（美国西门子医疗诊断公司）测量血小板成分的平均浓度。血栓弹力图分析显示，所有患有高血压疾病的女性组血浆止血活性均降低。与对照组相比，中度子痫前期和慢性动脉高血压女性的血小板功能活性未发生变化。在重度子痫前期队列中检测到致密血小板颗粒脱颗粒障碍及其聚集能力下降。在慢性动脉高血压背景下患有子痫前期的女性组中，观察到肾上腺素诱导的血小板聚集减少。血栓弹力图分析（R、K、角α、TMA、Cl、LY30）可能有助于重度子痫前期和慢性动脉高血压的鉴别诊断。研究结果得出结论，考虑到ADP和肾上腺素的粒细胞性及其分泌ATP的能力，建议使用低剂量的ADP和肾上腺素作为血小板聚集诱导剂。
