Hypofibrinogenemia is a risk factor of poor prognosis of HELLP syndrome / 中华检验医学杂志

Objective Observing changes in thehaemostatic system to determinetheseverity and prognosis of HELLP syndrome. Methods 127 cases of HELLP syndrome diagnosed in Peking University Third Hospital were enrolled from August 2010 to August 2018. Maternal and fetaldemographic characters, postpartum complications,length of hospital stay,prothrombin time(PT),activated partial thromboplastin time (APTT), Fibrinogen(Fg) and D-Dimer(D-D) were collected. Results There was no statistical difference inparturient PT, APTT, D-D levels between maternals of HELLP syndrome with and without postpartum hemorrhage,which were [9.6 (9.0, 11.5)s vs 9.4 (8.9, 9.7)s, P=0.243], [30.2 (29.1, 38.3)s vs 29.8 (27.7, 31.8)s, P=0.151], and [0.80 (0.52, 4.52)μg/ml vs 0.91 (0.55, 2.48)μg/ml, P=0.923] respectively. There was a statistically significant difference obvious difference in parturient Fglevels between two groups [(2.94±1.48) g/L vs (3.61±1.00)g/L, P=0.022). The receiver operating characteristic curve(ROC) analysis showed that the AUC of fibrinogen level when estimating postpartum hemorrhage was 0.688(95％CI:0.600-0.767), cut-off value was 3.04 g/L, negative predictive value was 74.3％. There was a negative correlation between parturient Fg and days of hospital stay of HELLP syndrome maternal(r=-0.182, P=0.040). There was no statistical difference in parturient PT, APTT, Fg and D-D levels between the fetal survival group(n=93) and non-survival group (n=34), and between the distressed group (n=23) and he undistressed group(n=70) (P>0.05). Conclusions The low parturient Fg level may be a risk factor of maternal adverse clinical outcomes in HELLP syndrome. Maintaining the Fg at a stable level may reduce the incidence of HELLP syndrome adverse outcomes.

Circulating microsome proteins in the pathogenesis of preeclampsia / 中华检验医学杂志

Objective In this study, we aimed to detect the level of total circulating microparticles (MPs) in pregnant women with preeclampsia (PE) and analyze the proteome of MPs to explore their roles in the pathogenesis and progression of PE. Methods 98 pregnant women with PE, 54 healthy pregnant women, and 51 healthy non-pregnant women were enrolled from December 2016 to June 2018, whose MP levels were detected by flow cytometry and compared. Proteins extracted from the MPs were analyzed by high performance liquid chromatography mass spectrometry.Results The total MP level of the healthy pregnant group was significantly higher than thatof the non-pregnant group [159.87 (113.25, 218.18)/μl vs 94.10 (53.35, 140.23)/μl, P=0.004], but was not significantly different from that of the PE group. By proteomic profiling, 30 differential proteins were obtained between healthy pregnant women and healthy non-pregnant women, which were closely related to biological processes such as complements, coagulation cascades, angiogenesis and so on; 14 differential proteins were found between PE patients and healthy pregnant women, which were closely related to biological processes such as coagulation cascades, complements and inflammatory reactions, angiogenesis and so forth. Conclusions The level of circulating MPs may reflect the hypercoagulability of preeclampsia. In addition, circulating MPs may be involved in the pathogenesis of PE through various pathways by carrying different proteins, which indicates their potential value in the intervention of PE.

Analysis of thromboinflammatory response expression profile in pregnancy and preeclampsia / 临床检验杂志

Objective@#To explore the differences of thromboinflammatory response between healthy pregnancy and preeclampsia (PE) and provide potential strategies for diagnosis and prevention of PE. @*Methods@#The antibody microarray was prepared to detect plasma protein expression profile of non-pregnant women, healthy pregnant women and preeclampsia patients. The differentially expressed proteins were identified and analyzed. @*Results@#The levels of 37 proteins were significantly different between non-pregnant and healthy pregnant women, among which 16 proteins were increased, such as disintegrin, metalloproteinase domain-containing protein 12 and C-C motif chemokine 2, while 21 proteins were decreased, such as GM-CSF and apolipoprotein F. The levels of 27 proteins were significantly different between healthy pregnant women and preeclampsia patients, among which 16 proteins were increased, such as GM-CSF and VEGFR2 and 11 proteins were decreased, such as tumor necrosis factor-related apoptosis-inducing ligand and interferon Omega 1. Further analysis found that PE patients group presented more complicated changes compared with healthy pregnant women. PE group included more significantly increased proteins which involved in inflammation and immune responses and elevated levels of acute phase reaction, while the levels of more anti-inflammation cytokines decreased significantly. In the plasma of PE patients more proteins participating thrombosis and complement reaction increased significantly. Also, renin level was significantly dropped and VEGFR2 was elevated. @*Conclusion@#More serious inflammatory response, hypercoagulable status and imbalance of angiogenesis and anti-angiogenesis may exist in PE, which should be helpful for further improving potential strategies in diagnosis and prevention of PE.