Etiopathogenetic components of microcirculatory disorders as risk factors of preeclampsia

Abstract

Background. The development of perinatal obstetrics is associated with the need for a detailed study of the pathophysiological mechanisms of preeclampsia (PE). Materials and methods. A prospective cohort study included 173 patients aged 18-45 years with a singleton pregnancy at a gestational age of 22-41 weeks at the Mordovian Republican Central Clinical Hospital. There were 3 groups: group I (n=63) – pregnant women with moderate PE, group II (n=58) – patients with severe PE, group III (control) (n=52) – pregnant women with physiological pregnancy. We studied parametrs of hemostasis, microcirculation and thromboelastography (TEG). The assessment of the prevalence of polymorphic variants of genes was by PCR diagnostics. Results. The course of preeclampsia was characterized with increase of the blood prothrombogenic potential. We occurred a decrease of the platelets number, prothrombin time and antithrombin III and an increase of fibrinogen. Hypercoagulation disorders according to TEG data demonstrate an increase in the strength and volume of a blood clot, which correlates with a deterioration in microcirculation. In patients with severe preeclampsia, the above hemocoagulation disorders are associated with a high prevalence of homozygous C/C variants (46.5%) of the ITGB3 gene and heterozygous C/T variants (55.5%) of the ITGA2 gene, hetero- (G/A) and homozygous (A/A) variants of the fibrinogen gene (FGB) – 48.3 and 36.2% comparably. In the study of the antioxidant system genes we found a high frequency of homozygous C/C variants (51.7%) of the superoxide dismutase gene and the high distribution of the T allele (61.2%) of the catalase gene. Conclusions. The course of preeclampsia is associated with significant hypercoagulation disorders, as well as intensification of lipid peroxidation processes. These changes correlate with the distribution of mutant alleles of the studied genes of the hemostasis and antioxidant systems, which can serve as a predictor of adverse obstetric and perinatal outcomes.

Keywords

• preeclampsia
• hemostasis system
• polymorphism
• genotype
• lipid peroxidation