Иммунологические причины синдрома задержки развития плода у беременных с антифосфолипидным синдромом

Abstract

Objective: to conduct a comparative analysis of the level of antibodies to phospholipids, the concentration of the pro-inflammatory cytokine TNF-α, as well as their correlation with the severity of fetal development retardation syndrome (FDS) and the outcome of pregnancy. Materials and methods. There was conducted a study of 285 pregnant women with FDS for the presence of antibodies to β2GPI as the most specific marker of the autoimmune process of APS in pregnancy 23–36 weeks. Group I included 103 (36.1%) women with a positive test for the presence of antibodies to β2GPI, group II (control) - 27 pregnant women of the same age and gestational age with physiological pregnancy. To study the immunological status, the titer of antibodies of the IgM and IgG class against cardiolipin was determined using enzyme immunoassay test systems produced by the «Genesis Diagnostics» company (Great Britain), and the titer of antibodies of the IgM class, IgG to β2GPI was tested using the «Biotech Inc» test systems (USA). Tests for the quantitative study of human TNF-α are based on the method of enzyme-linked immunosorbent assay using specific monoclonal antibodies TNF-α. Results. A statistically significant increase in all classes of antiphospholipid antibodies and TNF-α was revealed in pregnant women with FDS with an increase in gestational age compared with the control group. A significant increase in the levels of AKLA and antibodies to β2GPI IgG class in the II trimester (p <0.05) is also characteristic of pregnant women with FDS with a tendency to increase indicators in the III trimester. So, the average level of AKLA IgG in the II trimester was increased by 12.1 times; antibodies to β2GPI IgG - 7.4 times. In the III trimester, the average level of IgG AKLA was 11.7 times higher in comparison with the average level of similar indicators of the control group, and the average level of antibodies to β2GPI IgG class was 7.6 times higher than that in pregnant women with physiological pregnancy. A statistically significant direct correlation between the severity of FDS and the level of antibodies to β2GPI IgG (r = 0.61; p <0.01), SZRP and TNF-α (r = 0.41; p <0.01) was also revealed. Conclusion. The results of the study make it possible to predict the severity of FDS depending on the level of autoantibodies and indicators of the pro-inflammatory cytokine TNF-α, as well as determine the intensity and effectiveness of the treatment and preventive measures. Key words: pregnancy, antiphospholipid syndrome, fetal development retardation syndrome, tumor necrosis factor.