Судинні фактори та їхня роль у розвитку акушерських і перинатальних ускладнень у жінок з вірусним гепатитом В

Abstract

Purpose - to assess the role of vascular factors in the development of obstetric and perinatal complications in women with hepatitis B virus (HBV). Materials and methods. The serum parameters of peripheral venous blood were studied in 86 pregnant women with HBV (the main group, which was divided into 2 subgroups: HBV1 - 38 women with obstetric and perinatal complications; HBV2 - 48 pregnant women without significant gestational complications) and in 50 women without infectious liver disease (the control group). The state of the platelet and coagulation links of the haemostasis system and the main indicators of endothelial function (nitric oxide and endothelin-1) were determined. Results. In the vascular platelet system of pregnant women with HBV, a relative decrease in the number of platelets with an increase in their aggregation capacity and von Willebrand factor concentration was found, in the coagulation system - a decrease in fibrinogen with a slight decrease in the prothrombin index, recalcification time, international normalized ratio and an increase in activated partial thromboplastin time. The detected changes are even more pronounced in women with obstetric and perinatal complications (HBV1 subgroup): against the background of relative thrombocytopenia, the indicators of anisocytosis increase and the aggregation ability of platelets, the level of D-dimer and von Willebrand factor increase significantly. Endothelial dysfunction was found in women of the HBV1 subgroup (a decrease in the concentration of nitric oxide with an increase in endothelin-1). Conclusions. The state of the haemostatic system in pregnant women with HBV can be characterized as an unstable equilibrium, which can be easily disturbed by various exo- and endogenous factors, which is observed in women with obstetric and perinatal complications and is manifested by prothrombotic changes. Established endothelial dysfunction in pregnant women with HBV is a leading link in the pathogenesis of obstetric and perinatal complications in this category of patients. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.