Inflammatory markers and qualitative and quantitave high density lipoprotein particle characterization in preeclampsia risk assessment

[G. S. Marković]

152 str.

Farmacija - Medicinska biohemija / Pharmacy - Medical Biochemistry

Hipertenzivne komplikacije u trudnoći, uključujući i preeklampsiju, predstavljaju najčešće uzročnike morbiditeta i mortaliteta, kako majke, tako i fetusa. Prema preporukama Američkog društva za ginekologiju i akušerstvo (engl. American College of Obstetricians and Gynecologists – ACOG) dijagnoza hipertenzije u trudnoći postavlja se ukoliko je sistolni pritisak ≥140mmHg i/ili dijastolni pritisak ≥90mmHg kod trudnica koje nisu do tada imale dijagnozu hipertenzije. Preeklampsija (PE) se dijagnostikuje sa pojavom de novo hipertenzije (≥140/90 mmHg) nakon 20. nedelje gestacije, sa ili bez proteinurije (≥300 mg/24 h), ali uz kliničke znake edema, hematoloških poremećaja, renalne, pulmonarne ili hepatične disfunkcije. Prosečna globalna incidenca PE iznosi oko 4,6%. Prema Internacionalnom udruženju za ispitivanje hipertenzivnih oboljenja u trudnoći (engl. International Society for the Study of Hypertension in Pregnancy ISSHP), rana PE nastupa pre 34. nedelje gestacije i karakteriše je teža klinička slika češće udružena sa intrauterusnim zastojem u rastu ploda (engl. Intrauterine growth restriction, IURG) i prevremenim porođajem, dok se dijagnoza kasne PE postavlja nakon 34. nedelje gestacije, karakteriše je blaža klinička slika i u ređem broju slučajeva je praćena prevremenim porođajem. PE je multisistemska bolest čija etiologija i patogeneza još uvek intrigira kako stručnu, tako i naučnu javnost. Prema NICE (The National Institute for Health and Care Excellence) preporukama, trudnica je u riziku da razvije PE ukoliko ima više umerenih ili jedan faktor visokog rizika za razvoj PE, pri čemu su faktori visokog rizika: hipertenzija ili PE u prethodnoj trudnoći, hronična hipertenzija, bolesti bubrega, dijabetes mellitus tip 1 ili 2, autoimune bolesti i višeplodne trudnoće. Faktori umerenog rizika su : prva trudnoća, starost preko 40 godina, ITM ≥ 35 kg/m2, pozitivna porodična anamneza i period između trudnoća duži od 10 godina. Skrining koji NICE i ACOG vodiči preporučuju za ranu selekciju i tretman trudnica koje su u riziku ima nisku stopu detekcije, međutim u kombinaciji sa merenjem srednjeg arterijskog pritiska i pulsatilnog indeksa krvnih sudova materice, poboljšava se stepen predikcije. FMF (The Fetal Medicine Foundation) jedini preporučuje pristup procene rizika u prvom trimestru na osnovu faktora rizika majke, ultrazvučnih merenja, merenja protoka kroz arterije materice (UtA-Pi) i merenja biohemijskih markera angiogenze (placentalnog faktora rasta-PlGF, plazma proteina A udruženog sa trudnoćom-PAPP-A)...

Hypertensive complications during pregnancy, including preeclampsia (PE), are among the most common causes of morbidity and mortality for both the mother and fetus. According to the guidelines from the American College of Obstetricians and Gynecologists (ACOG), the diagnosis of pregnancyinduced hypertension is made when the systolic blood pressure reaches ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg in women who had not previously been diagnosed with hypertension. Preeclampsia is diagnosed when de novo hypertension (≥140/90 mmHg) arises after 20 weeks of gestation, with or without proteinuria (≥300 mg/24 h), accompanied by clinical signs such as edema, hematological disorders, and dysfunction in renal, pulmonary, or hepatic systems. The global average incidence of PE is around 4.6%. According to the International Society for the Study of Hypertension in Pregnancy (ISSHP), early-onset preeclampsia occurs before 34 weeks of gestation and is characterized by more severe clinical manifestations, often associated with intrauterine growth restriction (IUGR) and preterm birth. Late-onset preeclampsia, diagnosed after 34 weeks of gestation, typically presents with milder symptoms and is less frequently linked to preterm delivery. Preeclampsia is a multisystemic disorder, and its etiology and pathogenesis remain a subject of ongoing interest within both clinical and scientific communities. The National Institute for Health and Care Excellence (NICE) recommends that pregnant women at risk of developing PE should be identified based on the presence of multiple moderate risk factors or a single high-risk factor. High-risk factors include previous hypertension or preeclampsia, chronic hypertension, kidney disease, type 1 or type 2 diabetes, autoimmune diseases, and multiple pregnancies. Moderate risk factors include primigravida status, age over 40 years, body mass index (BMI) ≥35 kg/m², a positive family history, and a gap of more than 10 years between pregnancies. Although individual screenings are available, both NICE and ACOG guidelines continue to recommend screening for early selection and management of pregnant women at risk. Such screenings have a low detection rate, but when combined with measurements of mean arterial pressure and the uterine artery pulsatility index (UtA-PI), the detection rate improves. The Fetal Medicine Foundation (FMF) advocates for a first-trimester risk assessment approach based on maternal factors, ultrasound measurements, uterine artery blood flow (UtA-PI), and biochemical markers of angiogenesis (placental growth factor - PlGF and pregnancy-associated plasma protein A - PAPP-A)...

Visokorizična trudnoća, preeklampsija, inflamacija, lipoproteinske čestice visoke gustine

High-risk pregnancy, preeclampsia, inflammation, high-density lipoprotein particles

615:618.3(043.3)

Tekst