Факторы риска перинатальной и акушерской патологии в зависимости от цитокинового и оксидативного статуса беременной

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Факторы риска перинатальной и акушерской патологии

в зависимости от цитокинового и оксидативного статуса

беременной

Ye.V. Spiridonava, Ye.V. Kovalyov

To cite this version:



_

16/ Ɍɨɦ XXȱ / 4

 ɍȾɄ ȿ.ȼ. ɋɩɢɪɢɞɨɧɨɜɚ, ȿ.ȼ. Ʉɨɜɚɥɺɜ













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ɍɈ «ȼɢɬɟɛɫɤɢɣ ɝɨɫɭɞɚɪɫɬɜɟɧɧɵɣ ɦɟɞɢɰɢɧɫɤɢɣ ɭɧɢɜɟɪɫɢɬɟɬ» ɤɚɮɟɞɪɚ ɚɤɭɲɟɪɫɬɜɚ ɢ ɝɢɧɟɤɨɥɨɝɢɢ ȼɢɬɟɛɫɤ, 210023, Ɋɟɫɩɭɛɥɢɤɚ Ȼɟɥɚɪɭɫɶ Vitebsk State Medical University

Department of Obstetrics and Gynecology Vitebsk, 210023, Republic of Belarus e-mail: kovalev.vitebsk@synlab-eml.by

Ʉɥɸɱɟɜɵɟɫɥɨɜɚ ɚɦɧɢɨɬɢɱɟɫɤɚɹ ɠɢɞɤɨɫɬɶ, ɮɚɤɬɨɪɵ ɪɢɫɤɚ, ɰɢɬɨɤɢɧɵ, ɜɨɫɩɚɥɟɧɢɟ .H\ZRUGV amniotic fluid, risk factors, inflammation, cytokines



Ɋɟɮɟɪɚɬ Ɏɚɤɬɨɪɢ ɪɢɡɢɤɭ ɩɟɪɢɧɚɬɚɥɶɧɨʀ ɣ ɚɤɭɲɟɪɫɶɤɨʀ ɩɚɬɨɥɨɝɿʀ ɡɚɥɟɠɧɨ ɜɿɞ ɰɢɬɨɤɿɧɨɜɨɝɨ ɣ ɨɤɫɢ ɞɚɬɢɜɧɨɝɨ ɫɬɚɬɭɫɭ ɜɚɝɿɬɧɨʀ ɋɩɢɪɢɞɨɧɨɜɚɈȼ Ʉɨɜɚɥɶɨɜȯȼ Ɇɟɬɨɸ ɞɨɫɥɿɞɠɟɧɧɹ ɛɭɥɨ ɜɫɬɚɧɨɜɢɬɢ ɮɚɤɬɨɪɢ ɪɢɡɢɤɭ ɩɟɪɢɧɚɬɚɥɶɧɢɯ ɩɨɲɤɨɞɠɟɧɶ ɭ ɧɨɜɨɧɚɪɨɞɠɟɧɢɯ ɡɚɥɟɠɧɨ ɜɿɞ ɪɿɜɧɹ ɫɟɤɪɟɰɿʀ ɜ ɧɚɜɤɨɥɨɩɥɿɞɧɨɦɭ ɫɟɪɟɞɨɜɢɳɿ ɰɢɬɨɤɿɧɿɜ ɿ ɧɿɬɪɚɬɿɜ / ɧɿɬɪɢɬɿɜ. ȼɫɶɨɝɨ ɛɭɥɨ ɨɛɫɬɟɠɟɧɨ 464 ɩɚɰɿɽɧɬɤɢ. ȼɦɿɫɬ 1ȕ, 2, 4, ȱɅ-10, ɿɧɬɟɪɮɟɪɨɧɭ-Ȗ, Ɏɇɉ-Į ɜ ɚɦɧɿɨɬɢɱɧɿɣ ɪɿɞɢɧɿ ɜɢɡɧɚɱɚɥɢ ɦɟɬɨɞɨɦ ɬɜɟɪɞɨɮɚɡɧɨɝɨ ɿɦɭɧɨɮɟɪɦɟɧɬɧɨɝɨ ɚɧɚɥɿɡɭ, ɜɢɡɧɚɱɟɧɧɹ ɧɿɬɪɚɬɿɜ ɿ ɧɿɬɪɢɬɿɜ ɭ ɧɚɜɤɨɥɨɩɥɿɞɧɢɯ ɜɨɞɚɯ ɩɪɨɜɨɞɢɥɢ ɡɚ ɦɟɬɨɞɨɦ Ƚɪɿɫɫɚ ɜ ɦɨɞɢɮɿɤɚɰɿʀ ȱ.ɋ. ȼɟɪɟɦɿɣ ɬɚ ɿɧ. ȼɢɜɱɟɧɨ ɪɟɡɭɥɶɬɚɬɢ ɩɨɥɨɝɿɜ, ɫɬɚɧ ɧɨɜɨɧɚɪɨɞɠɟɧɢɯ ɿ ɦɨɪɮɨɥɨɝɿɱɧɭ ɛɭɞɨɜɭ ɩɨɫɥɿɞɿɜ. Ɂ ɦɟɬɨɸ ɜɢɡɧɚɱɟɧɧɹ ɮɚɤɬɨɪɿɜ ɪɢɡɢɤɭ ɛɭɥɢ ɪɨɡɪɚɯɨɜɚɧɿ ɜɿɞɧɨɲɟɧɧɹ ɲɚɧɫɿɜ (ȼɒ) ɞɥɹ ɪɟɡɭɥɶɬɚɬɿɜ ɩɨɥɨɝɿɜ, ɩɟɪɢɧɚɬɚɥɶɧɨʀ ɩɚɬɨɥɨɝɿʀ ɬɚ ɩɨɲɤɨɞɠɟɧɶ ɩɥɚɰɟɧɬɢ. ȼɫɬɚɧɨɜɥɟɧɨ, ɳɨ ɡɚɝɨɫɬɪɟɧɧɹ ɯɪɨɧɿɱɧɨɝɨ ɩɿɽɥɨɧɟɮɪɢɬɭ ɩɿɞ ɱɚɫ ɜɚɝɿɬɧɨɫɬɿ ɡɛɿɥɶɲɭɽ ȼɒ ɪɨɡɜɢɬɤɭ ɩɟɪɢɧɚɬɚɥɶɧɨʀ ɩɚɬɨɥɨɝɿʀ ɧɟɪɜɨɜɨʀ ɫɢɫɬɟɦɢ ɜ 9,6 ɪɚɡɭ ([95% Ⱦȱ 3,8; 17,0], ɪ=0,008) ɿ ɧɚɪɨɞɠɟɧɧɹ ɦɚɥɨɜɚɝɨʀ ɞɢɬɢɧɢ – ɭ 13,2 ([95% Ⱦȱ 4,3; 25,3]; ɪ=0,03]). ɉɪɢ ɮɨɪɦɭɜɚɧɧɿ ɫɢɧɞɪɨɦɭ «ɤɨɪɨɬɤɨʀ» ɲɢɣɤɢ ɦɚɬɤɢ ɩɿɞ ɱɚɫ ɜɚɝɿɬɧɨɫɬɿ ɡɛɿɥɶɲɭɽɬɶɫɹ ȼɒ ɪɨɡɜɢɬɤɭ ɪɟɫɩɿɪɚɬɨɪɧɨɝɨ ɞɢɫɬɪɟɫ-ɫɢɧɞɪɨɦɭ ɭ 8,0 ɪɚɡɿɜ ([95% Ⱦȱ 2,2; 16,7], ɪ=0,019), ɩɟɪɢɧɚɬɚɥɶɧɨʀ ɩɚɬɨɥɨɝɿʀ ɧɟɪɜɨɜɨʀ ɫɢɫɬɟɦɢ – ɜ 11,4 ([95% Ⱦȱ 2,8; 17,3], ɪ=0,005). Ƚɨɫɬɪɿ ɪɟɫɩɿɪɚɬɨɪɧɿ ɿɧɮɟɤɰɿʀ ɞɨ 18 ɬɢɠɧɿɜ ɡɛɿɥɶɲɭɸɬɶ ȼɒ ɪɨɡɜɢɬɤɭ ɪɟɫɩɿɪɚɬɨɪɧɨɝɨ ɞɢɫɬɪɟɫ-ɫɢɧɞɪɨɦɭ ɜ 27,6 ([95% Ⱦȱ 11,7; 46,2], ɪ=0,021), ɡɚɬɪɢɦɤɢ ɪɨɫɬɭ ɩɥɨɞɚ ɜ 11,0 ɪɚɡɿɜ ([95% Ⱦȱ 2 , 0; 21,6], ɪ=0,006). ɉɟɪɟɞɱɚɫɧɿ ɩɨɥɨɝɢ ɿ ɪɟɚɥɿɡɚɰɿɹ ȼɍȱ ɫɭɩɪɨɜɨɞɠɭɸɬɶɫɹ ɡɧɢɠɟɧɧɹɦ ɭ ɧɚɜɤɨɥɨɩɥɿɞɧɨɦɭ ɫɟɪɟɞɨɜɢɳɿ ɤɨɧɰɟɧɬɪɚɰɿʀ ȱɅ-4, ȱɅ-10 ɿ ɩɨɫɢɥɟɧɧɹɦ ɚɤɬɢɜɧɨɫɬɿ ȱɅ-2, ɿɧɬɟɪɮɟɪɨɧɭ-Ȗ ɩɪɢ ɫɢɧɟɪɝɿɱɧɨɦɭ ɡɛɿɥɶɲɟɧɧɿ ɤɨɧɰɟɧɬɪɚɰɿʀ NO2- / NO3-. ɉɟɪɢɧɚɬɚɥɶɧɨɦɭ ɩɨɲɤɨɞɠɟɧɧɸ ɧɟɪɜɨɜɨʀ ɫɢɫɬɟɦɢ ɩɪɢ ɧɚɹɜɧɨɫɬɿ ɡɚɝɨɫɬɪɟɧɧɹ ɯɪɨɧɿɱɧɨɝɨ ɩɿɽɥɨɧɟɮɪɢɬɭ, ȽɊȱ ɜ ɬɟɪɦɿɧɿ ɞɨ 18 ɬɢɠɧɿɜ, ɫɢɧɞɪɨɦɭ «ɤɨɪɨɬɤɨʀ» ɲɢɣɤɢ ɦɚɬɤɢ, ɉɊɉɈ ɩɟɪɟɞɭɽ ɡɧɢɠɟɧɧɹ ɜɦɿɫɬɭ ɜ ɚɦɧɿɨɬɢɱɧɿɣ ɪɿɞɢɧɿ ȱɅ-4 ɬɚ ȱɅ-10, ɡɦɟɧɲɟɧɧɹ ɤɨɧɰɟɧɬɪɚɰɿʀ NO2- / NO3- ɿ ɡɛɿɥɶɲɟɧɧɹ ɩɪɨɡɚɩɚɥɶɧɨʀ ɚɤɬɢɜɧɨɫɬɿ ɡɚ ɪɚɯɭɧɨɤ ɎɇɈ-Į.



$EVWUDFW 5LVN IDFWRUV RI SHULQDWDO DQG REVWHWULF SDWKRORJ\ GHSHQGLQJ RQ F\WRNLQHV DQG R[LGDWLYH VWDWXV RI D SUHJQDQW 6SLULGRQDYD<H9 .RYDO\RY<H9 The aim of the study was to determine risk factors for perinatal

damage in newborns depending on the level of cytokines secretion and nitrate/nitrite amount in the amniotic mileu. A total of 464 patients were examined. The content of IL-1ȕ, IL-2, IL-4, IL-10, IFN-Ȗ, TNF-Į in the amniotic fluid were determined by ELISA, evaluation of nitrate and nitrite amount was performed by Griess reaction in Veremey et al. modification. Outcomes of labor, neonatal status and morphological structure of placentas were studied. To determine the risk factors odds ratios (OR) for delivery outcomes, perinatal pathology and damage the placenta were calculated. It was found that the exacerbation of chronic pyelonephritis during pregnancy increases the odds of perinatal pathology of the nervous system by 9.6 times ([95% CI 3.8, 17.0], p=0.008) and low birth weight – by 13.2 ([95% CI 4.3, 25.3]; p=0.03]). The syndrome of "short" cervix during pregnancy increases the odds of respiratory distress syndrome by 8.0 times ([95% CI 2.2, 16.7], p=0.019), perinatal pathology of the nervous system by 11.4 ([95% CI 2.8, 17.3], p=0.005). Acute respiratory infections up to 18 weeks increase the or of respiratory distress syndrome by 27.6 ([95% CI 11.7, 46.2], p=0.021), fetal growth retardation by 11.0 times ([95% CI 2 0, 21.6], p=0.006). Preterm delivery and implementation of intrauterine infection is followed by a decrease of IL-4, IL-10 concentration and enhancement of IL-2, IFN-Ȗ in the amniotic mileu with synergistic increase in the concentration of NO2-_/NO3-_{. Perinatal damage of the}

nervous system in the presence of acute pyelonephritis, acute respiratory infections in the term of up to 18 weeks, syndrome of "short" cervix, PROM is preceded by reduction of IL-4 and IL-10, decrease of NO2- / NO3- and increased activity of TNF-Į in the amniotic mileu.

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ɪɟɚɥɢɡɚɰɢɹ ȼɍɂ ɫɨɩɪɨɜɨɠɞɚɸɬɫɹ ɫɧɢɠɟɧɢɟɦ ɩɪɨɬɢɜɨɜɨɫɩɚɥɢɬɟɥɶɧɨɣɚɤɬɢɜɧɨɫɬɢɜɨɤɨɥɨɩɥɨɞ ɧɨɣ ɫɪɟɞɟ ɡɚ ɫɱɟɬ ɂɅ ɂɅ ɢ ɭɫɢɥɟɧɢɟɦ ɚɤ ɬɢɜɧɨɫɬɢ ɩɪɨɬɢɜɨɜɨɫɩɚɥɢɬɟɥɶɧɨɣ ɫɨɫɬɚɜɥɹɸɳɟɣ ɡɚ ɫɱɺɬ ɂɅ ɢɧɬɟɪɮɟɪɨɧɚȖ ɩɪɢ ɫɢɧɟɪɝɢɱɧɨɦ ɭɜɟɥɢɱɟɧɢɢɤɨɧɰɟɧɬɪɚɰɢɢ1212  Ɋɟɚɥɢɡɚɰɢɢ ɩɟɪɢɧɚɬɚɥɶɧɨɝɨ ɩɨɜɪɟɠɞɟɧɢɹ ɧɟɪɜɧɨɣ ɫɢɫɬɟɦɵ ɩɪɢ ɧɚɥɢɱɢɢ ɬɚɤɢɯ ɮɚɤɬɨɪɨɜ ɪɢɫɤɚ ɤɚɤ ɨɛɨɫɬɪɟɧɢɟ ɯɪɨɧɢɱɟɫɤɨɝɨ ɩɢɟɥɨ ɧɟɮɪɢɬɚ ɈɊɂ ɜ ɫɪɨɤɟ ɞɨ  ɧɟɞɟɥɶ ɫɢɧɞɪɨɦɚ ©ɤɨɪɨɬɤɨɣª ɲɟɣɤɢ ɦɚɬɤɢ ɉɊɉɈ ɩɪɟɞɲɟɫɬɜɭɟɬ ɫɧɢɠɟɧɢɟ ɩɪɨɬɢɜɨɜɨɫɩɚɥɢɬɟɥɶɧɨɣ ɚɤɬɢɜɧɨɫɬɢ ɚɦɧɢɨɬɢɱɟɫɤɨɣ ɠɢɞɤɨɫɬɢ ɂɅ ɂɅ ɭɦɟɧɶ ɲɟɧɢɟ ɤɨɧɰɟɧɬɪɚɰɢɢ 1212 ɢ ɭɜɟɥɢɱɟɧɢɟ ɩɪɨɜɨɫɩɚɥɢɬɟɥɶɧɨɣɚɤɬɢɜɧɨɫɬɢɡɚɫɱɟɬɎɇɈĮ

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