Horn Christine E, Bravo Maria Cristina, Orfeo Thomas, McLean Kelley, Bernstein Ira
The Robert Larner, MD College of Medicine, University of Vermont, Given Medical Bldg, 89 Beaumont Ave, Burlington, VT 05405, USA.
Department of Pathology and Laboratory Medicine, The Robert Larner, MD College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT 05405, USA.
Pregnancy Hypertens. 2025 Jun;40:101221. doi: 10.1016/j.preghy.2025.101221. Epub 2025 May 8.
To evaluate whether a history of preterm preeclampsia (PreP) is associated with abnormal hemostatic features during the non-pregnant state, relative to people without a history of preeclampsia.
We conducted a retrospective sub-analysis of three prospective IRB approved studies in which individuals were evaluated outside of pregnancy during the follicular phase of their menstrual cycles. We compared parameters between subjects with prior PreP (n = 21) with a combined cohort (NL, n = 74) of healthy nulliparous subjects (n = 57) and subjects with a prior normotensive pregnancy (n = 17). T-tests were employed with P < 0.05 accepted for significance.
Levels of eight coagulation factors, protein C (PC), and thrombin generation (TG) were assessed in the presence or absence of thrombomodulin (TM) to evaluate the activation of the anticoagulant PC pathway.
There were no differences in TG or factor composition between healthy nulliparous and healthy primiparous people. In contrast, the PreP cohort had increased levels of factors II, V, VII, IX, X, XI, and PC compared to the NL cohort without this history. In dynamic assays examining TG in the presence of TM, the PreP group had reduced rates (nM/min) of formation and diminished peak levels when compared to the NL group.
Increased procoagulant factor levels are typically associated with increased TG, suggesting here that individuals with prior PreP would have a procoagulant shift in the non-pregnant state. However, the observed concurrent increase in anticoagulant PC linked with a decrease in dynamic TG suggests a possible compensatory mechanism to maintain hemostatic balance.
评估与无先兆子痫病史的人群相比，早产先兆子痫（PreP）病史是否与非妊娠状态下的异常止血特征相关。
我们对三项经机构审查委员会（IRB）批准的前瞻性研究进行了回顾性亚分析，这些研究中的个体在月经周期的卵泡期进行了非孕期评估。我们将既往有PreP的受试者（n = 21）与健康未生育受试者（n = 57）和既往有血压正常妊娠史的受试者（n = 17）组成的联合队列（NL，n = 74）进行了参数比较。采用t检验，P < 0.05为有统计学意义。
在有或无血栓调节蛋白（TM）的情况下，评估八种凝血因子、蛋白C（PC）和凝血酶生成（TG）的水平，以评估抗凝PC途径的激活情况。
健康未生育者和健康经产妇之间的TG或因子组成没有差异。相比之下，与无此病史的NL队列相比，PreP队列中因子II、V、VII、IX、X、XI和PC的水平有所升高。在存在TM的情况下检测TG的动态分析中，与NL组相比，PreP组的生成速率（nM/分钟）降低，峰值水平降低。
促凝血因子水平升高通常与TG升高相关，这表明既往有PreP的个体在非妊娠状态下会出现促凝血转变。然而，观察到的抗凝PC同时增加与动态TG降低相关，提示可能存在一种维持止血平衡的代偿机制。
