Вміст оксипроліну та глікозаміногліканів у сироватці крові у жінок з невиношуванням вагітності на ранніх і пізніх термінах

Abstract

Однією з гострих проблем акушерства та гінекології є покращення репродуктивного здоров’я жінок та забезпечення повноцінної реалізації генеративної функції. Мета дослідження – оцінити у жінок з різними термінами переривання вагітності стан метаболізму сполучної тканини шляхом визначення у сироватці крові вмісту оксипролінових фракцій та сумарних глікозаміногліканів. Обстежено 227 вагітних жінок, з них 190 мали клінічні ознаки загрози передчасних пологів у термін гестації 23-36 тижнів. Виявлені зміни метаболізму сполучної тканини у вагітних жінок свідчать про порушення адаптаційно-компенсаторних механізмів та можливість сприяння розвитку передчасних пологів і погіршенню внутрішньоутробного стану плода.

Одной из острых проблем акушерства и гинекологии является улучшение репродуктивного здоровья женщин и обеспечения полноценной реализации генеративной функции. Цель исследования – оценить у женщин с различными сроками прерывания беременности состояние метаболизма соединительной ткани путем определения в сыворотке крови содержания оксипролиновых фракций и суммарных гликозаминогликанов. Обследовано 227 беременных женщин, из них 190 имели клинические признаки угрозы преждевременных родов в срок гестации 23-36 недель. Выявленные изменения метаболизма соединительной ткани у беременных женщин свидетельствуют о нарушении адаптационно-компенсаторных механизмов и возможность содействия развитию преждевременных родов и ухудшению внутриутробного состояния плода.

The acute problem of obstetrics and gynecology is the improvement of women’s reproductive health, especially in order to reduce the level of perinatal loss and ensure the full implementation of the generative function. Causes of early termination of pregnancy and preterm births are not fully understood and multifactorial. This stimulates a wide interest of specialists in this problem in order to identify an effective set of measures for the prevention of reproductive losses and the development of obstetric complications. Adaptive processes, the organs and systems stability of pregnant woman body are dependent on the metabolic processes occurring in the connective tissue. Connective tissue is a mediator of inflammatory and immune mechanisms in the body of a pregnant woman. Changes in the metabolism of connective tissue in women with fetal loss in the early and late stages of pregnancy have not been studied sufficiently, which makes this kind of research. In addition, the involvement of women with preterm labor to people with emotional stress is interest to assess the adaptive reserves of the body, primarily, by the metabolism of the structural components of the connective tissue – collagen and glycosaminoglycans. The purpose of the study is to evaluate the state of connective tissue metabolism in women with different periods of abortion by determining the content of oxyproline fractions and total glycosaminoglycans in the serum. Object and methods of research. 227 pregnant women were examined, 190 of them had clinical signs of premature birth in the period of gestation 23-36 weeks. Group II was involved in 142 women (mean age 24.7 ± 4.2 years) with a late-onset preterm pregnancy period of 28 to 36 weeks. Formation of clinical groups was carried out depending on the term of pregnancy in the form of premature and timely birth. 48 women with early onset of pregnancy (mean age 23.6 ± 5.1 years) were included in group I, which ended in childbirth in the period from 23 to 27 weeks. The III (control) group included 37 women with a physiological course of pregnancy (mean age 26.1 ± 2.7 years), which ended with birth without complications at the time of 38-41 weeks. The criteria for including women into groups were: young reproductive age, single-pregnancy, absence of gestosis, acute and chronic gynecological and somatic diseases. Diagnosis of preterm labor was carried out in the presence of abdominal pain syndrome and structural changes in the cervix. The research was carried out in compliance with the bioethics principles. Conclusions. The predominance of catabolic processes over anabolic occurs in connective tissue in women with early premature pregnancy, which ended in childbirth at the time of 23-27 weeks, in relation to women with the physiological course of pregnancy, ended in childbirth without complications. This is confirmed by an increase in blood serum total glycosaminoglycans (13%, p = 0.0123), a simultaneous increase in the level of linked (29%, p <0.001) and free (81%, p <0.001) oxyproline in the background decrease (p <0,001) of the coefficient of their ratio by 30%. The predominance of anabolic processes over catabolic is observed in women with late premature pregnancy, which ended in childbirth in the period of 28-36 weeks, in relation to women with the physiological course of pregnancy. This is confirmed by a drop in blood serum total glycosaminoglycans (10%, p <0.001), a simultaneous increase in the level of related (by 138%, p <0.001) and free (38%, p <0.001) oxyproline against the background of ( p <0,001) of their ratio of 48%. The revealed changes in the connective tissue metabolism in pregnant women indicate a violation of the adaptivecompensatory mechanisms and the possibility of promoting the preterm birth development and the deterioration of the fetal state of the fetus.