Аksonova A. Prognostication the development of pre-eclampsia based on the study of markers of atherogenic dysfunction

The dissertation is devoted to theoretical generalization and perspective solution of the actual scientific problem of contemporary obstetrics - to increase the efficiency of diagnosis and possibilities of predicting the development of pre-eclampsia by studying the changes in the production of atherogenic and antiangiogenic vascular markers in blood serum and doppler parameters of blood flow velocity in the uterine arteries of pregnant women. Studies demonstrated that in women with pre-eclampsia have already pronounced shifts in lipid metabolism in the form of dyslipidemia occured with the increasing of the atherogenic potential of blood serum due to hypertriglyceridemia and decreasing in high-density lipoproteins from the second trimester of pregnancy. The risk of the development this pathology increases with the increasing in serum triglyceride levels and is >1,73 mmol/L for mild pre-eclampsia and >1,86 mmol/L for moderate and severe stages. For women with this complication during pregnancy we noted the increased prevalence of the 34CG+34GG lipid exchange genotypes for the PPAR-gama gene and ins/del+del/del for the ApoB gene, and the lung development risks of its forms increases with 34CG PPAR-gama mutation and ins/del+del/delApoB, and the chances of developing severe forms are significantly increasing in the case of 34CG+34GG mutations in the PPAR-gama gene. An early predictor of development the preeclampsia is the soluble form of the vascular endoglin, whose concentration in the serum >=5400 pg/ml reliably predicts the occurrence of the pathology. The growth of cardiac indices in women with medium-severe forms of pathology has been noted. The risk of developing pre-eclampsia increases with an increasing in serum triglyceride levels > 1.73 mmol/L for mild pre-eclampsia and > 1.86 mmol/L for moderate to severe conditions. It was established that determination of the pulsation index in the doplerometry of the uterine arteries in combination with elevated levels of atherogenic triglycerides and vascular endoglin significantly predicts the development of severe forms of preeclampsia. It was found that women with a genetic predisposition to atherogenic damage during pregnancy trigger mechanisms of violation of placental processes, which further contribute to the development of preeclampsia, which is confirmed by the signs of atherosis in the spiral arteries of the placenta, the presence of sudanophilic macrophages and inflammatory lymphocytic infiltration in the decidual envelope. The degree of gravity of pre-eclampsia correlates with the severity of the atherosis of the spiral arteries (coefficient of association of Kappa 0,630) and other structural components of the placenta, which can be considered one of the criteria for its development. Clinical and diagnostic algorithm for managing patients, which predicts the development of preeclampsia, is improved. The prognostic model of the risk of preeclampsia is developed by means of a mathematical method of binary logistic regression, predictive accuracy of the model is 88 %.