DOI: https://doi.org/10.18370/2309-4117.2020.51.47-50

The state of the fibrinolytic system in HIV-infected pregnant women and parturient women with thrombohemorrhagic risk factors

С. Є. Савченко, О. І. Гервазюк, Л. М. Онищик, Ю. С. Мудра, Г. Б. Бойко

Abstract


Purpose of the study: to explore the status of the fibrinolytic system in HIV-infected pregnant women and parturient women.

Materials and methods. 120 HIV-positive pregnant women with risk factors of thrombohemorrhagic complications were examined. The main group included: IA-O subgroup – 10 patients with HIV-infection stage I who received high-activity antiretroviral therapy before this pregnancy, IB-O subgroup – 20 patients with HIV-infection stage I who started high-activity antiretroviral therapy during this pregnancy, II-O – 21 pregnant women with HIV infection II clinical stage, III-O subgroup – 24 women with HIV-infection III clinical stage. Comparison group consisted of 45 patients with HIV infection without thrombohemorrhagic complications; control group consisted of 40 pregnant women and parturient women without HIV. D-dimer, soluble fibrin-monomer complexes, antithrombin III and XIIa-dependent fibrinolysis time were evaluated.

Study results. In II-O and III-O subgroups there were changes of fibrinolytic system state in 18–22 weeks of pregnancy – increased D-dimer and soluble fibrin-monomer complexes, XIIa-dependent fibrinolysis time prolongation and antithrombin III decreased. With pregnancy progression the main group with HIV stage III showed a significant increase of soluble fibrin-monomer complexes and D-dimer with a tendency to XIIa-dependent fibrinolysis time reduction and antithrombin III decreasing. In all women of the main group there were thrombosis signs. In subgroup III-O there were laboratory signs of fibrinolysis activation (shortening the time of XIIa-dependent fibrinolysis) and a tendency to antithrombin III decrease. Parturient women who started taking high-activity antiretroviral therapy during this pregnancy show a slowing of the fibrinolysis processes (shortening of XIIa-dependent fibrinolysis) and a tendency to antithrombin III decrease. In IB-O subgroup there was a further suppression of fibrinolysis (prolonging the time of XIIa-dependent fibrinolysis).

Conclusions. Changes in the fibrinolytic system toward suppression of the fibrinolysis process during pregnancy and it activation during labor are significantly present in HIV-infected pregnant women and in women with risk factors for thrombogemorrhagic complications.


Keywords


HIV infection; thrombogemorrhagic complications; fibrinolysis system; antiretroviral therapy; pregnancy; childbirth

References


Shaboltas, A.V. “The psychological basis for the prevention of HIV infection.” St. Petersburg. Scythia-print (2015): 694 p.

Puzyreva, L.V., et al. “Analysis of the causes of death in patients with HIV infection.” Zabaykal'skiy meditsinskiy vestnik 2 (2016): 29–32.

Vozna, H.I., Moskalyuk, V.D. “Endothelial dysfunction in ills at HIV/AIDS.” Infectious Diseases 3 (2014): 16–21.

Ovchinnikov, V.V., et al. “Adaptive changes in plasma hemostasis and its reference values during physiological pregnancy in women of the Kirov region.” Vyatskiy meditsinskiy vestnik 2.50 (2016): 39–45.

Shamray, V.S., et al. “Pregnancy against the background of diseases of the blood system: risks, management tactics, prospects.” Glavnyi vrach Uga Russia 1. 53 (2017): 13–8.

Makatsaria, A.D., Chervenak, F.A., Bitsadze, V.O. High-risk pregnancy: a monograph. Moscow (2015): 930 p.

Medved, V.I. “Venous thromboembolism in obstetrics. Key points of international and national recommendations.” Medical aspects of women's health 10 (2015): 5–9.

Pavlovskaya, Y.M., Vorobyova, N.A. “Fibrinogen and factor XIII during pregnancy.” Journal of Medical and Biological Research 1 (2015): 68–75.

Bibas, M., Gianluigi, B., Antinori, A. “HIV-associated venous thromboembolism.” Mediterranean journal of hematology and infectious diseases 3.1 (2011): 31–49.

Ozolinya, L.A., Ovsepyan, N.R. “Correction of changes in hemostasis with habitual miscarriage during a chronic viral infection.” Meditsynskiy sovet 13 (2017): 110–7.

Bubovich, E.V., Darvin, V.V. “Anemia, thrombocytopenia, coagulopathy: pathogenesis and possible options for their correction in HIV-infected patients.” Meditsinskaya nauka i obrazovaniye Urala 18.4 (2017): 7–12.

Golyshko, B.C., et al. “The frequency and characteristics of cardiovascular diseases in HIV-infected patients (according to autopsy).” Klinicheskaya meditsina 95.10 (2017): 928–34.

Daminov, T.A., Khudaykulova, G.K., Rakhmatullaeva, Sh.B. “Thrombocytopenia in HIV infection in children.” Herald of Tashkent Medical Academy 2.30 (2018): 135–7.

Bates, S.M., et al. “Guidance for the treatment and prevention of obstetric-associated venous thromboembolism.” Journal of thrombosis and thrombolysis 41.1 (2016): 92–128.

Filippov, P.G., et al. “Features of the course of HIV infection in the development of systemic inflammation syndrome: clinical cases.” Infectious Diseases: News, Opinions, Training 3 (16) (2016): 93–9.

Babiuk, D.V., Kovaleva, O.S., Lenets, E.A. “Evaluation of hemostasis in patients with liver cirrhosis and HIV infection.” Advanced Science (2019): 318–21.

Guzovskaya, E.V., Serebrennikova, S.N. “Pathogenetic features of disseminated intravascular coagulation syndrome of various etiologies.” Patologicheskaya fiziologiya i eksperimental'naya terapiya 61.2 (2017): 76–81.

Asakura, Hidesaku. “Classifying types of disseminated intravascular coagulation: clinical and animal models.” Journal of intensive care 2.1 (2014): 1–7.

Wada Hideo, Takeshi Matsumoto, Yoshiki Yamashita. “Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines.” Journal of Intensive Care 2.1 (2014): 1–8.

Diachenko, A. G., Grabovyi, S.L., Kurganska, V.A., Diachenko, P.A HIV infection (theory and practice). Sumy State University. Sumy (2015): 210 p.

Dolgushin, I.I., Gizinger, O.A., Shishkova, Y.S., et al. HIV infection. Etiology, pathogenesis, laboratory diagnostics: the manual. Chelyabinsk (2015): 85 p.

Kalinin, R.E., et al. “Effect of activity of factors of the internal coagulation cascade and hemostatic markers of endothelial dysfunction on thrombotic complications in patients with atherosclerotic diseases of the peripheral arteries.” Novosti Khirurgii 25.6 (2017): 643–54.

Berkovsky, A.L., et al. External coagulation pathway. Research methods: methodological guide. Moscow (2016): 70 p.

Yarovaya, G.A., et al. The internal pathway of blood coagulation: a training manual. Moscow. FGBOU DPO RMANPO (2017): 68 p.

Volkova, S.A., Borovkov, N.N. The basics of clinical hematology: a training manual. Nizhny Novgorod. Publishing House of the Nizhny Novgorod State Medical Academy (2013): 400 p.

Glinkin, E.I., Odinokova, A.A. Assessment of the functional state of the hemostatic system. Tambov University Reports. Series: Natural and Technical Sciences 21.6 (2016): 2334–9.

Marchenko, A.I., et al. “Investigation of the physical properties of blood and changes in the coagulation link of hemostasis, DIC.” Khirurg 6 (2016): 30–5.


GOST Style Citations


1.            Шаболтас, А.В. Психологические основы превенции ВИЧ-инфекции / А.В. Шаболтас. – СПБ: Скифия-принт, 2015. – 694 с.

2.            Пузырева, Л.В. Анализ причин летальных исходов у пациентов с ВИЧ-инфекцией / Л.В. Пузырева и др. // Забайкальский медицинский вестник. – 2016. – № 2. – С. 29–32.

3.            Возна, Х.І. Ендотеліальна дисфункція у хворих на ВІЛ-інфекцію/СНІД / Х.І. Возна, В.Д. Москалюк // Інфекційні хвороби. – 2014. – № 3. – С. 16–21.

4.            Овчинников, В.В. Адаптационные изменения плазменного гемостаза и его референсные значения при физиологической беременности у женщин Кировской области / В.В. Овчинников и др. // Вятский медицинский вестник. – 2016. – № 2 (50). – С. 39–45.

5.            Шамрай, В.С. Беременность на фоне заболеваний системы крови: риски, тактика ведения, перспективы / В.С. Шамрай и др. // Главный врач Юга России. – 2017. – № 1 (53). – С. 13–18.

6.            Макацария, А.Д. Беременность высокого риска : монография / А.Д. Макацария, Ф.А. Червенак, В.О. Бицадзе. – М., 2015. – 930 с.

7.            Медведь, В.И. Венозный тромбоэмболизм в акушерстве. Основные положения международных и национальных рекомендаций / В.И. Медведь // Медичні аспекти здоров’я жінки. – 2015. – № 10. – С. 5–9.

8.            Павловская, Ю.М. Фибриноген и фактор XIII при беременности / Ю.М. Павловская, Н.А. Воробьева // Журнал медико-биологических исследований. – 2015. – № 1. – С. 68–75.

9.            Bibas, M., Gianluigi, B., Antinori, A. “HIV-associated venous thromboembolism.” Mediterranean journal of hematology and infectious diseases 3.1 (2011): 31–49.

10.          Озолиня, Л.А. Коррекция изменений гемостаза при привычном невынашивании беременности на фоне хронической вирусной инфекции / Л.А. Озолиня, Н.Р. Овсепян // Медицинский совет. – 2017. – № 13. – С. 110–117.

11.          Бубович, Е.В. Анемия, тромбоцитопения, коагулопатия: патогенез и возможные варианты их коррекции у ВИЧ-инфицированных пациентов / Е.В. Бубович, В.В. Дарвин // Медицинская наука и образование Урала. – 2017. – № 4 (18). – С. 7–12.

12.          Голышко, В.С. Частота и характеристика сердечно-сосудистых заболеваний у ВИЧ-инфицированных пациентов (по данным аутопсии) / В.С. Голышко и др. // Клиническая медицина. – 2017. – № 10 (95). С. 928–934.

13.          Daminov, T.A., Khudaykulova, G.K., Rakhmatullaeva, Sh.B. “Thrombocytopenia in HIV infection in children.” Herald of Tashkent Medical Academy 2.30 (2018): 135–7.

14.          Bates, S.M., et al. “Guidance for the treatment and prevention of obstetric-associated venous thromboembolism.” Journal of thrombosis and thrombolysis 41.1 (2016): 92–128.

15.          Филиппов, П.Г. Особенности течения ВИЧ-инфекции при развитии синдрома системного воспаления: клинические случаи / П.Г. Филиппов и др. // Инфекционные болезни: новости, мнения, обучение. – 2016. – № 3 (16). – С. 93–99.

16.          Бабюк, Д.В. Оценка показателей гемостаза у пациентов, больных циррозом печени и ВИЧ-инфекцией / Д.В. Бабюк, О.С. Ковалева, Е.А. Ленец // Advanced science. – 2019. – С. 318–321.

17.          Гузовская, Е.В. Патогенетические особенности синдрома диссеминированного внутрисосудистого свертывания крови различной этиологии / Е.В. Гузовская, С.Н. Серебренникова // Патологическая физиология и экспериментальная терапия. – 2017. – № 2 (61). –С. 76–81.

18.          Asakura, Hidesaku. “Classifying types of disseminated intravascular coagulation: clinical and animal models.” Journal of intensive care 2.1 (2014): 1–7.

19.          Wada Hideo, Takeshi Matsumoto, Yoshiki Yamashita. “Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines.” Journal of Intensive Care 2.1 (2014): 1–8.

20.          Дьяченко, А.Г. ВИЧ-инфекция (теория и практика) / А.Г. Дьяченко, С.Л. Грабовый, В.А. Курганская, П.А. Дьяченко. – Суми: СумГУ, 2015. – 210 с.

21.          Долгушин, И.И. ВИЧ-инфекция. Этиология, патогенез, лабораторная диагностика: Учебное пособие / И.И. Долгушин, О.А. Гизингер, Ю.С. Шишкова и др. – Челябинск, 2015. – 85 с.

22.          Калинин, Р.Е. Влияние активности факторов внутреннего каскада коагуляции и гемостатических маркеров эндотелиальной дисфункции на тромботические осложнения у пациентов с атеросклеротическими заболеваниями периферических артерий / Р.Е. Калинин и др. // Новости хирургии. – 2017. – № 6 (25). – С. 643–654.

23.          Берковский, А.Л. Внешний путь свертывания крови. Методы исследования: методическое руководство / А.Л. Берковский и др. – М.: 2016. –70 с.

24.          Яровая, Г.А. Внутренний путь свертывания крови: учебно-методическое пособие / Г.А. Яровая и др. – М.: ФГБОУ ДПО РМАНПО, 2017. – 68 с.

25.          Волкова, С.А. Основы клинической гематологии: учебное пособие / С.А. Волкова, Н.Н. Боровков // Н. Новгород: Изд-во Нижегородской гос. медицинской академии, 2013. – 400 с.

26. Глинкин, Е.И. Оценка функционального состояния системы гемостаза / Е.И. Глинкин, А.А. Одинокова // Вестник Тамбовского университета. Серия: Естественные и технические науки. – 2016. – № 6 (21). – С. 2334–2339.

27. Марченко, А.И. Исследование физических свойств крови и изменение коагуляционного звена гемостаза, ДВС-синдром / А.И. Марченко и др. // Хирург. – 2016. – № 6. – С. 30–35.





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