diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12682diaendo-12682Research ArticleОригинальные исследованияOriginal StudiesОсобенности состояния коагуляционного и сосудисто-тромбоцитарного звена гемостаза у беременных с различными типами сахарного диабетаThe hemostatic parameters in pregnant women with different types of diabetes mellitushttps://orcid.org/0000-0002-2783-3032КапустинР. В.KapustinR. V.

Капустин Роман Викторович, кандидат медицинских наук , учёный секретарь, врач акушер-гинеколог отделения патологии беременности

199034, Санкт-Петербург, Менделеевская линия, д. 3

Researcher ID: G-3759-2015;

eLibrary SPIN: 7300-6260

 

Roman V. Kapustin, MD, PhD

3 Saint Petersburg, Mendeleyevskaya line, 199034

Researcher ID: G-3759-2015;

eLibrary SPIN: 7300-6260

 

kapustin.roman@gmail.comhttps://orcid.org/0000-0002-9328-8909КоптееваЕ. В.KopteevaE. V.

Коптеева Екатерина Вадимовна, клинический ординатор

Медицинский факультет

Санкт-Петербург

eLibrary SPIN: 9421-6407

Ekaterina V. Kopteeva, clinical resident

Saint Petersburg

eLibrary SPIN: 9421-6407

 

ekaterina_kopteeva@bk.ruhttps://orcid.org/0000-0003-3059-9811АржановаО. Н.ArzhanovaO. N.

Аржанова Ольга Николаевна, доктор медицинских наук, профессор , ведущий научный сотрудник отдела акушерства и перинаталогии

Санкт-Петербург

eLibrary SPIN: 7910-6039

Olga N. Arzhanova, MD, PhD, Professor

Saint Petersburg

eLibrary SPIN: 7910-6039

olga_arjanova@mail.ruhttps://orcid.org/0000-0002-2512-833XТиселькоА. В.TiselkoA. V.

Тиселько Алена Викторовна, кандидат медицинских наук , ведущий научный сотрудник отдела гинекологии и эндокринологии

Санкт-Петербург

eLibrary SPIN: 9010-7276

Alena V. Tiselko, MD, PhD

Saint Petersburg

eLibrary SPIN: 9010-7276

alenadoc@mail.ruhttps://orcid.org/0000-0003-0693-9150АндросоваН. Е.AndrosovaN. Е.

Андросова Наталия Евгеньевна, врач клинической лабораторной диагностики

Санкт-Петербург

 

Nataliia E. Androsova

Saint Petersburg

androsova_ne@mail.ruhttps://orcid.org/0000-0001-5133-2396ОпаринаТ. И.OparinaT. I.

Опарина Татьяна Ивановна, кандидат биологических наук , биолог клинико-диагностической лаборатории

Санкт-Петербург

eLibrary SPIN: 2719-5432

Tatiana I. Oparina, PhD in Biology

Saint Petersburg

eLibrary SPIN: 2719-5432

oparinat@mail.ruНИИ акушерства, гинекологии и репродуктологии им. Д.О. Отта; Санкт-Петербургский государственный университетРоссияThe Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott; St. Petersburg State UniversityRussian FederationСанкт-Петербургский государственный университет (медицинский факультет)РоссияSt. Petersburg State UniversityRussian FederationНИИ акушерства, гинекологии и репродуктологии им. Д.О. ОттаРоссияThe Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. OttRussian Federation202129062021243251261Copyright © Капустин Р.В., Коптеева Е.В., Аржанова О.Н., Тиселько А.В., Андросова Н.Е., Опарина Т.И., 20212021Капустин Р.В., Коптеева Е.В., Аржанова О.Н., Тиселько А.В., Андросова Н.Е., Опарина Т.И.Kapustin R.V., Kopteeva E.V., Arzhanova O.N., Tiselko A.V., Androsova N.Е., Oparina T.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/12682ОБОСНОВАНИЕ

ОБОСНОВАНИЕ. Распространенность различных типов сахарного диабета (СД) во время беременности неуклонно растет. Гестационная гиперкоагуляция является физиологическим состоянием, однако беременность, протекающая на фоне СД, сопряжена с большим риском венозных тромбоэмболических осложнений (ВТЭО). Несмотря на широкое освещение особенностей показателей системы гемостаза у женщин с СД вне беременности, аналогичных исследований у беременных с учетом различных типов СД и методов его коррекции недостаточно.

ЦЕЛЬ

ЦЕЛЬ. Оценка показателей коагуляционного и сосудисто-тромбоцитарного звена гемостаза у беременных с различными типами СД с учетом метода его коррекции.

МЕТОДЫ

МЕТОДЫ. Проведено обсервационное одноцентровое ретроспективное когортное исследование на базе ФГБНУ «НИИ АГиР им. Д.О. Отта». В исследование вошли 1994 беременных, которые составили несколько групп сравнения в зависимости от типа СД и метода его коррекции, группу женщин с преэклампсией (ПЭ) и условно здоровых. Проводился анализ клинических и лабораторных данных амбулаторных и стационарных карт беременных женщин, находящихся на диспансерном учете, при сроке 28–32 нед в период с 2012 по 2017 гг. Для исследования использовалась периферическая венозная кровь, взятая у беременных натощак при сроке 28–32 нед. За первичную конечную точку исследования принимали показатели содержания фибриногена, протромбинового индекса, тромбинового времени, активированного парциального тромбопластинового времени, международного нормализованного отношения, антитромбина III, D-димера, фактора Виллебранда и фибронектина. Дополнительно оценивалась частота развития венозных тромбоэмболических осложнений во время беременности и в течение 6 нед после родов, гестационной артериальной гипертензии, ПЭ, задержки развития плода, преждевременных родов, случаи антенатальной гибели плода.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. У беременных с различными типами СД и ПЭ по сравнению со здоровыми женщинами наблюдается состояние патологической гиперкоагуляции, характеризующееся увеличением содержания и активацией следующих показателей в крови: фибриноген, степень и скорость агрегации тромбоцитов, D-димер, гомоцистеин, фактор Виллебранда и фибронектин. В то же время содержание антитромбина III было значимо снижено у пациенток с СД. При проведении корреляционного анализа установлена прямая связь между содержанием изученных факторов со степенью гликемических нарушений и частотой основных акушерских осложнений.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. СД и ПЭ ассоциированы со сдвигом системы гемостаза в сторону гиперкоагуляции и гиперэкспрессией синтеза маркеров эндотелиальной дисфункции. При этом выраженность этих процессов может зависеть как от типа СД, так и выраженности метаболических нарушений. Наличие СД во время беременности требует особого внимания к показателям коагуляции, регулярного их мониторинга и при необходимости своевременного назначения профилактического лечения.

BACKGROUND

BACKGROUND: The prevalence of diabetes mellitus (DM) in pregnancy is on the rise. Despite that gestational hypercoagulability is a physiological condition, diabetic pregnancy is associated with a high risk of venous thromboembolic complications (VTEC). There are many surveys related to the hemostatic parameters in non-pregnant women, but studies in pregnant women are not enough.

AIMS

AIMS: To assess the coagulation and vascular-platelet hemostasis parameters in pregnant women with various types of diabetes mellitus, taking into account its correction method. The data were compared with these indicators in women with preeclampsia and healthy pregnant women at the same gestational age.

MATERIALS AND METHODS

MATERIALS AND METHODS: An observational, single-center, retrospective cohort study was carried out at D.O. Ott ­Research Institute of Obstetrics, Gynecology, and Reproductive Medicine. The study included 1994 pregnant women who presented several groups taking into account the type of DM and its correction method, a group of women with preeclampsia (PE), and healthy women. The analysis of clinical data was carried out at 28–32 gestational weeks from 2012 to 2017. The study’s primary endpoint was taken as indicators of fibrinogen content, prothrombin index, thrombin time, activated partial thromboplastin time (APTT), and international normalized ratio (INR) antithrombin III, D-dimer, von Willebrand factor, and fibronectin. Additionally, the incidence of VTEC during pregnancy and within six weeks after delivery, gestational arterial hypertension, preeclampsia, fetal growth restriction, premature birth, and stillbirth cases was assessed.

RESULTS

RESULTS: in pregnant women with various types of diabetes mellitus and preeclampsia, a state of pathological hypercoagulation was observed compared to the control group. These changes were characterized by an increase and activation of the following blood parameters: fibrinogen, the degree and rate of platelet aggregation, D-dimer, homocysteine, von Willebrand factor, and fibronectin. At the same time, the content of antithrombin III was significantly reduced in patients with DM. Correlation analysis established a direct relationship between the range of the studied factors with the degree of glycemic control and the frequency of obstetric complications.

CONCLUSIONS

CONCLUSIONS: Diabetes mellitus in pregnancy is associated with a hypercoagulation condition and overexpression in the synthesis of endothelial dysfunction markers. Moreover, the severity of these processes depends on the type of DM and the severity of metabolic disorders. In diabetic pregnancy, exceptional attention to coagulation indicators, regular monitoring, and preventive treatment is required in order to improve the perinatal outcomes.

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The authors declare that there are no conflicts of interest present.