Медицинская иммунология (May 2019)
FEATURES OF THE SYNTHESIS OF CYTOKINES AND PLACENTAL DYSFUNCTION IN PREGNANT WOMEN WITH ACUTE PANCREATITIS
Abstract
Pancreatitis ranks third in the structure of acute surgical diseases of the abdominal cavity. The development of this pathology during pregnancy is complicated by premature birth in 58% of cases, which directly affects the indicators of perinatal morbidity and mortality.Objective: to study the features of cytokine synthesis and their impact on the state of the fetoplacental system in acute pancreatitis in pregnant women, as well as to evaluate the effectiveness of the developed complex of therapeutic measures for the correction of violations and prevention of complications of gestation.Material and methods. The study included 127 pregnant women with acute pancreatitis. The main group consisted of 43 pregnant women, who were additionally included in the complex of therapeutic and preventive measures: discrete plasmapheresis for 1 and 3 days and micronized progesterone (patent for the invention № 2535108 from 08.10.2014). In the comparison group (n=84), standard therapy of acute pancreatitis was performed. The control group (n=30) was represented by healthy pregnant women. The examination was carried out in accordance with the standards, the content of cytokines (interleukins IL-1β, IL-4, interferon IFN-γ, tumor necrosis factor TNF-α), the marker of apoptosis of Fas-ligand, hemodynamic parameters in the uterine arteries, the concentration of trophoblastic beta-1-glycoprotein (TBG) and placentospecific alpha-1-microglobulin (PAMG-1) in serum were additionally studied blood pregnant.Research result. The combination of pregnancy with acute pancreatitis revealed increased levels of IFN-γ – 2.5-fold, IL-1β – 2.1 times, TNF-α – 2.5 times, IL-4 – 1.3 times in comparison with control data on the background of decrease in Fas-L – in 1,3 times and increase of indexes of peripheral resistance in the uterine artery in 1.3-1.4 times, which was accompanied by the exclusion of gravidarum synthesis of proteins: a decrease in TBG (1.3 times) and increase of PAMG-1 (1.9 times). Dynamic control of the studied parameters showed the preservation of high concentrations of cytokines and progression of uterine hemodynamic disorders in the standard treatment of the disease, which led to the appearance of signs of threatening termination of pregnancy on 7-10 days in 83.3% of women. In addition, the development of pancreatitis at different gestation periods increases the risk of spontaneous miscarriage to 11.9%, non – developing pregnancy – up to 29.8%, premature birth-up to 60.7%, as a result of the formation of chronic (78.9%) and acute (21.1%) placental insufficiency. The additional use of discrete plasmapheresis and progesterone drugs helped to restore the balance of Pro-and anti-inflammatory cytokines by the 3rd day of treatment, preventing their long-term negative impact on the structure and function of the utero-placental complex.Conclusion. The combination of pregnancy with acute pancreatitis is accompanied by dissociation of the immune response with predominance of Th1-cytokines against the background of apoptosis oppression and placental dysfunction development. The use of the developed method of complex treatment allows to reduce the frequency of threatening termination of pregnancy with the development of acute pancreatitis – 3 times, reduce the number of premature births – 13 times, and reduce pregnancy losses to zero.
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