Association Of The Changes Of Plasma Protein S,Protein C And Antithrombin ? Activity With Preeclampsia

Background and ObjectivePreeclampsia(PE)is a common obstetric complication,mainly characterized by new-onset hypertension that developed after 20 weeks of gestation(systolic blood pressure?140mmHg and/or diastolic blood pressure?90mmHg),and proteinuria(?0.3g in a 24-hour urine collection or one dipstick demonstrating?2+protein).Preeclampsia is a.disease caused by multiple factors and involving multiorgan dysfunction.Despite advances in fetomaternal management and Perinatal critical care medicine,preeclampsia is still a major cause of threats to maternal and infant health and maternal and neonatal morbidity and mortality worldwide,especially in developing countries.At present,Although the exact mechanisms of Preeclampsia are still not fully understood,several factors have been proposed and are well accepted:placental stress,thrombophilia,and exaggerated systemic inflammation.Thrombophilia is a pathological condition in the body characterized by an increased risk of intravascular thrombosis due to hereditary and/or acquired diseases.For pregnant women,thrombophilia not only increases the risk of thrombosis,but also increases the risk of adverse pregnancy outcomes,such as,preeclampsia,fetal intrauterine growth restriction,recurrent miscarriage,stillbirth,during pregnancy and within a few weeks postpartum.The mechanisms of preeclampsia caused by thrombophilia are related to spontaneous microthrombophilia events on placental blood vessels,which leads to placental infarction,abnormal trophoblast invasion and chronic hypoxia,and these mechanisms are associated with increased resistance in the uterine arteries.Many scholars around the world have conducted extensive research on the impact of thrombophilia on pregnancy outcomes.There is an increasing evidence that the pathogenesis of preeclampsia involves abnormal enhancement of coagulation activity.Protein S(PS),Protein C(PC),and antithrombin ?(AT?)are important coagulation inhibitors of serine proteases of the coagulation system,which play an important role in the balance of coagulation and anticoagulation activity,When PC exerts anticoagulant effect,PC will be activated into activated protein C(APC),and activated protein S can act as a cofactor of APC.The combination of PC and activated protein S can inactivate FVa and FVIIIa,and as a result,reducing the production of thrombin;AT? is the most important anticoagulant factor of the coagulation system which can exert anticoagulant effect through inhibiting the activity of serine proteases,such as,FX?a,FXIa,FIXa and FXa of the coagulation system.Studies have shown that the decrease of plasma PS,PC,and AT? activity can trigger thrombophilia of the coagulation system.We suspect that the decrease in plasma PS,PC and AT? activity during pregnancy may be associated with the onset of preeclampsia.At the present study,plasma PS,PC and AT? activities were detected in patients with early-onset and late-onset preeclampsia groups and corresponding healthy pregnant women.Plasma PS,PC and AT? activity levels were compared between the preeclampsia group and the healthy pregnant women group to investigate whether changes in Plasma PS,PC and AT? activity were associated with the onset of preeclampsia,so as to provide a new reference for accurate treatment of preeclampsia.Materials and Methods1.From January 2018 to April 2019,89 preeclampsia patients with regular birth checkups and complete medical records at the First Affiliated Hospital of Zhengzhou University were selected,of which 53 cases were in the early-onset preeclampsia group(<34 weeks)and 36 cases were in the late-onset eclampsia group(?34 weeks).During the same period,74 healthy pregnant women with regular birth checkups and complete medical records were randomly selected as the control group,of which 30 were in control group 1(<34 weeks)and 44 were in control group 2(?34 weeks).Under fasting conditions,3 ml of cubital vein blood was drawn from the subjects.This study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University[Approval Number:2019-KY-360].2.The test instrument were ACL TOP700 automatic hemagglutination analyzer produced by Wolfen Company.Plasma PS activity was detected by coagulation method;plasma PC and AT? activity were detected by chromogenic substrate method.The non-pregnancy reference intervals of PS,PC and AT? activity were(76-135)%,(70-140)%and(83-128)%,respectively.3.Statistical analysis was performed using SPSS21.0 software.And all Measurement data were expressed by x�s,and independent sample t test was used for comparison of measurement data between normal distribution.The non-normal distribution of measurement data between groups were compared using non-parametric tests.A P value<0.05 was considered to be statistically significant.Results1.The plasma PS,AT? activity were significantly lower in cases with early-onset preeclampsia compared with control group 1(all P<0.05).There was no significant difference in PC activity in cases with early-onset preeclampsia compared with control group 1(P>0.05).2.The plasma PS,AT? activity were significantly lower in cases with late-onset preeclampsia compared with control group 2(all P<0.05).There was no significant difference in PC activity in cases with late-onset preeclampsia compared with control group activity 2(P>0.05)..3.The plasma PS,PC and AT? activity of pregnant women with early-onset preeclampsia group were not significantly different from those with late-onset preeclampsia group(all P>0.05).4.The plasma PS activity of pregnant women in control group 1 and control group 2 were lower than the reference range of non-pregnancy,and the activity of PC and ATIII were within the reference range of non-pregnancy,There were no significant differences in PS,PC and AT? activity between control group 1 and control group 2(allP>0.05).Conclusion1.In healthy pregnant women,there is a decrease in plasma PS activity during pregnancy.Changes in plasma PS,PC,and AT? activity may have little effect on changes of hypercoagulable blood system of healthy pregnant women in late pregnancy.2.Decreased plasma PS and AT? activity may be closely associated with the onset of preeclampsia.Changes in plasma PC activity may have little effect on the onset of preeclampsia;Changes in plasma PS and AT? activities may not be associated with the onset of gestational weeks of preeclampsia.3.The detection of maternal plasma PS and AT? activity may have certain clinical value for evaluating the thrombophilia of Pregnant women with preeclampsia;Although the mechanisms of early-onset preeclampsia and late-onset preeclampsia are not exactly the same,both patients with early-onset and late-onset preeclampsia may exist thrombophilia caused by decreased plasma PS and AT? activity.