Характеристика липидного обмена при беременности осложненной внутриутробным инфицированием

Abstract

Дослідження присвячене визначенню наявності та характеру порушень ліпідного обміну крові у вагітних з внутрішньоутробним інфікуванням. Обстежені вагітні жінки з вірусною, бактеріальною та змішаною інфекцією з її подальшою реалізацією у новонароджених і без неї. Для ліпідного спектра крові вагітних з внутрішньоутробною вірусною та бактеріальною інфекцією є характерним підвищення рівня фракцій атерогенних ліпідів і ліпопротеїнів, в порівнянні з аналогічними показниками при вагітності, що протікає фізіологічно. При змішаній інфекції розвивається гіперхолестеринемія та гіпертригліцеридемія. У вагітних з реалізацією інфекції вірусно-бактеріального генезу відзначається підвищення рівня загального холестерину та основної його транспортної форми ЛПНЩ. Подібні зміни ліпідного обміну є компенсаторною захисною реакцією на токсини, що виділяються мікроорганізмами, ряд з яких володіє ліполітичними властивостями.

Исследование посвящено определению наличия и характера нарушений липидного обмена крови у беременных с внутриутробным инфицированием. Обследованы беременные женщины с вирусной, бактериальной и смешанной инфекцией с последующей реализацией инфекции у новорожденных и без нее. Для липидного спектра крови беременных с внутриутробной вирусной и бактериальной инфекцией характерно повышение уровня фракций атерогенных липидов и липопротеинов, по сравнению с аналогичными показателями при физиологически протекающей беременности. При смешанной инфекции развивается гиперхолестеринемия и гипертриглицеридемия. У беременных с реализацией инфекции вирусно-бактериального генеза отмечается повышение уровня общего холестерина и основной его транспортной формы ЛПНП. Подобные изменения липидного обмена являются компенсаторной защитной реакцией на выделяемые микроорганизмами токсины, ряд из которых обладает липолитическими свойствами.

Various pathological conditions in pregnancy can cause disturbances in homeostasis, including manifestations of lipid metabolism disorders and changes in lipid spectrum of blood. Intrauterine infection with various agents, both viral and bacterial, plays a special role in this state. The purpose of this study was to determine the presence and nature of lipid metabolism disorders in pregnant with intrauterine infection. The study involved examination of 147 pregnant, who were divided into 3 groups (42 patients each): with viral (CMV, HSV-1, 2, 6), bacterial (chlamydia, ureaplasma, mycoplasma) and mixed infection. Each of these groups was divided into 2 subgroups: with subsequent implementation of infection in newborns (1) and without it (0). Control group included 21 patients with physiological pregnancy. Blood serum of the pregnant was screened for total cholesterol (TC), triglycerides (TG), high, low and very low density lipoproteins (HDL, LDL, VLDL). The findings showed that the mean values, as well as medians and the range of variations in the main blood lipids (total cholesterol and triglycerides) were generally higher than in the control group. A significant increase in indices in the subgroup with implementation of viral infection (B1) was noted for TG (Kruskal-Wallis test, р<0,01) and LDL (Kruskal-Wallis test, р<0,01). In the subgroup without implementation (B0), TG (Kruskal-Wallis test, р<0,01), VLDL (Kruskal-Wallis test, р<0,01) and LDL (Kruskal-Wallis test, р<0,01) indices were significantly increased. TC indices showed a tendency to increase as compared to the norm. HDL indices in both subgroups did not differ significantly from the norm, although in subgroup B0 this indicator was slightly higher than in group B1. In the group of patients with bacterial infection, lipid spectrum tended to increase as compared to the norm. It was only a tendency for TC in both subgroups with bacterial infection (B1 and B0); however, it was expressed to a lesser extent than in viral infection. In subgroup B1, a significant increase was observed in TG indices (Kruskal-Wallis test, р<0,01) and VLDL (Kruskal-Wallis test, р<0,01); in subgroup B0, the level of these indices was significantly increased: TG (Kruskal-Wallis test, р<0,01) and VLDL (Kruskal-Wallis test, р<0,01). Lipid spectrum of blood of the pregnant with intrauterine viral and bacterial infection was characterized by an increase in the level of fractions of atherogenic lipids and lipoproteins as compared to the indices in physiological pregnancy. The group of patients with mixed infection, the only one among all other groups, was found to have statistically significant differences between the indices in the subgroups with and without infection. There was a clear tendency to exceed the level of TC in pregnant with implementation of infection as compared to this indicator in patients without implementation. However, this excess is significant for the main transport form of lipoproteins for cholesterol in the blood, LDL (Kruskal-Wallis test, р<0,01). Assessment of the obtained results on changes in the lipid spectrum of blood in pregnant with intrauterine infection showed more pronounced hyperlipidemic direction as compared to physiological pregnancy. It should be noted that in infection by agents of one type, only by viruses or bacteria, a significant increase as compared to control was typical for triglycerides and their transport form VLDL, and cholesterol had only a tendency to increase. The presence or absence of subsequent implementation of the existing infection in this case did not play a role; there were no significant differences between the indices in the selected subgroups. Mixed viral-bacterial infection was accompanied by the development of hypercholesterolemia and hypertriglyceridemia with a corresponding increase in the level of LDL and VLDL. At the same time, this group of patients, the only one among all other groups, was found to have some differences between the indices in the subgroups with implementation of the infection and without it. There was a noticeable tendency to exceed the level of TC in pregnant in the subgroup with implementation of the infection and a significant increase in its basic LDL transport form. Thus, it can be concluded that such changes in lipid metabolism are a compensatory protective reaction to toxins released by microorganisms, some of which have lipolytic properties.