Патогенетическая взаимосвязь эндотелиальной дисфункции и нарушений коагуляционного потенциала крови при беременности, осложненной развитием преэклампсии

Abstract

Until now, there is no systematic information on the role of endothelial dysfunction in the mechanisms of disorders of blood coagulation potential and microcirculation in different organs and tissues in preeclampsia. Objective : Our aim was to extend the existing principles of diagnosis of pre-eclampsia by establishing the role of endothelial dysfunction in the mechanisms of blood coagulation potential violations. Methods: A prospective comparative study was performed. Condition of coagulation processes studied by conventional techniques, parameters of a functional endothelium (nitric oxide metabolites, endothelin 1, thrombospondin, thrombomodulin and intercellular adhesion molecules in blood plasma) — by ELISA. Results : The study group included 55 patients with moderate preeclampsia and 49 pregnant women with severe pre-eclampsia, in the control group — 40 women with physiological pregnancy. In patients with pre-eclampsia moderate observed increase in plasma endothelin-1 (p <0.001), thrombospondin (p <0.001), intercellular adhesion molecules (p <0.001) while reducing the level of nitrogen oxide (p <0.001), increase in time of fibrinolysis (p <0.050) and decreased international normalized ratio (p <0.050) compared with the control group. With increasing severity of preeclampsia the researchers detected in blood plasma of patients a progressive increase in endothelin 1 (p1 <0.020), thrombospondin (p1 <0.001), intercellular adhesion molecules (p1 <0.001) and decrease of nitric oxide metabolites (p1 <0.001) and thrombomodulin (p1 <0.001); the last combined with the activation of procoagulant hemostasis. Conclusion : There is a pathogenetic relationship between the development of endothelial dysfunction, impaired blood coagulation potential and the severity of clinical signs of preeclampsia. To widen the number of existing techniques to diagnose the severity of pre-eclampsia we recommende to mesure endothelin 1, thrombomodulin, thrombospondin, intercellular adhesion molecules and nitric oxide metabolites in the blood plasma, and use traditional indicators to assess the hemostatic system.