Avaliação de aspectos da função plaquetária e do sistema do complemento na hipertensão gestacional

Detalhes bibliográficos
Autor(a) principal: Moraes, Daniela
Data de Publicação: 2022
Tipo de documento: Tese
Idioma: por
Título da fonte: Biblioteca Digital de Teses e Dissertações da PUC_RS
Texto Completo: https://tede2.pucrs.br/tede2/handle/tede/10487
Resumo: Introduction:Hypertensive disorders are one of the most frequent complications of pregnancy, being responsible for a high rate of maternal-fetal death. Preeclampsia Syndrome (PES) is characterized by elevated blood pressure and pathological proteinuria after the 20th week of gestation, and may have outcomes such as HELLP syndrome, eclampsia, preterm pregnancy and restricted intrauterine growth. Imbalance in hemostatic mechanisms can occur during pregnancy with a tendency for hypercoagulability and increased thrombosis risk. In pregnant women with hypertensive disorders, especially in preeclampsia (PE), this risk is increased. There is a suggestion of increased thrombin generation, activation of the complement system and release of antiangiogenic factors. Pregnant women with hypertensive disorder, especially preeclampsia, show alterations in platelet indexes, mean platelet volume (MPV), immature platelet fraction (IPF), thrombin generation and soluble membrane attack complex(sC5b9). IPF has been suggested as a sensitive index for monitoring changes in platelet production and destruction. Objectives: To evaluate IPF, MPV and C5b9 in patients diagnosed with a gestational hypertensive disorders (GHD). Material and method: A cross-sectional study was conducted in pregnant women with normotensive pregnancy (NP), preeclampsia syndrome (PES) or non-proteinuric hypertensive pregnancy (nPHP). Following ethical approval and written informed consent, samples were collected. Platelet count and indexes were measured by fluorescent flow cytometry by automated counters XE-5000 and XN-3000 (Sysmex Corporation, Roche, Kobe, Japan). Plasma and serum samples were frozen at -80°C for laterdetermination of sC5b9 by ELISA. Results: A total of 111 pregnant women were included and divided into three groups: PES, nPHP and NP with 47,30 and 34 women, respectively. Results are presented in the following sequence: PES, nPHP and NP. MVP was 12.18±1.6, 11.5±1.2 and 10.8±0.99 fL (P<0.001);IPF was 7.4 (1.9-21.8), 6.8(2.4-17) and 4.9(1.3-9.7)% (P=0.004); platelets counts were 199127±52864, 225827±80728 and 240323±54321 /uL (P=0.012). sC5b9 was 1040 (706-1433), 1221(849-1771) and 1471(1085-1986) ng/mL (P=0.023). Conclusion: MPV and IPF are increased and platelet count is decreased in patients with SPE compared to controls. sC5b9 was increased in controls in comparison with SPE. Controls and HGsP group had similar sC5b9 levels. There was no association between platelet indexes and sC5b9. MPV and IPF are measurements can be obtained quickly, have low-cost and are easily accessible in hospitals that use advanced technology for blood counts. It is suggested that these markers could be used in daily routine as an additional tool in the management of pregnant women. More studies are needed to understand the activation of the complement system in pregnancy and PES and the interaction between platelets and the complement pathway.
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spelling Figueiredo, Carlos Eduardo Poli dehttp://lattes.cnpq.br/7183837354797239Munhoz, Terezinha Pazhttp://lattes.cnpq.br/8174437987130152http://lattes.cnpq.br/8186156084479821Moraes, Daniela2022-09-26T15:00:55Z2022-05-30https://tede2.pucrs.br/tede2/handle/tede/10487Introduction:Hypertensive disorders are one of the most frequent complications of pregnancy, being responsible for a high rate of maternal-fetal death. Preeclampsia Syndrome (PES) is characterized by elevated blood pressure and pathological proteinuria after the 20th week of gestation, and may have outcomes such as HELLP syndrome, eclampsia, preterm pregnancy and restricted intrauterine growth. Imbalance in hemostatic mechanisms can occur during pregnancy with a tendency for hypercoagulability and increased thrombosis risk. In pregnant women with hypertensive disorders, especially in preeclampsia (PE), this risk is increased. There is a suggestion of increased thrombin generation, activation of the complement system and release of antiangiogenic factors. Pregnant women with hypertensive disorder, especially preeclampsia, show alterations in platelet indexes, mean platelet volume (MPV), immature platelet fraction (IPF), thrombin generation and soluble membrane attack complex(sC5b9). IPF has been suggested as a sensitive index for monitoring changes in platelet production and destruction. Objectives: To evaluate IPF, MPV and C5b9 in patients diagnosed with a gestational hypertensive disorders (GHD). Material and method: A cross-sectional study was conducted in pregnant women with normotensive pregnancy (NP), preeclampsia syndrome (PES) or non-proteinuric hypertensive pregnancy (nPHP). Following ethical approval and written informed consent, samples were collected. Platelet count and indexes were measured by fluorescent flow cytometry by automated counters XE-5000 and XN-3000 (Sysmex Corporation, Roche, Kobe, Japan). Plasma and serum samples were frozen at -80°C for laterdetermination of sC5b9 by ELISA. Results: A total of 111 pregnant women were included and divided into three groups: PES, nPHP and NP with 47,30 and 34 women, respectively. Results are presented in the following sequence: PES, nPHP and NP. MVP was 12.18±1.6, 11.5±1.2 and 10.8±0.99 fL (P<0.001);IPF was 7.4 (1.9-21.8), 6.8(2.4-17) and 4.9(1.3-9.7)% (P=0.004); platelets counts were 199127±52864, 225827±80728 and 240323±54321 /uL (P=0.012). sC5b9 was 1040 (706-1433), 1221(849-1771) and 1471(1085-1986) ng/mL (P=0.023). Conclusion: MPV and IPF are increased and platelet count is decreased in patients with SPE compared to controls. sC5b9 was increased in controls in comparison with SPE. Controls and HGsP group had similar sC5b9 levels. There was no association between platelet indexes and sC5b9. MPV and IPF are measurements can be obtained quickly, have low-cost and are easily accessible in hospitals that use advanced technology for blood counts. It is suggested that these markers could be used in daily routine as an additional tool in the management of pregnant women. More studies are needed to understand the activation of the complement system in pregnancy and PES and the interaction between platelets and the complement pathway.Introdução: Os distúrbios hipertensivos são das complicações mais frequentes da gestação, sendo responsáveis por um alto índice de morte materno-fetal. A Síndrome de Pré-eclâmpsia (SPE) caracteriza-se por elevação da pressão arterial e proteinúria patológica após a 20ª semana de gestação, podendo apresentar desfechos como síndrome HELLP (Hemólise, elevação das enzimas hepáticas e plaquetas baixas), eclâmpsia, gestação pré-termo e crescimento intrauterino restrito. Adaptações nos mecanismos hemostáticos ocorrem durante a gestação com tendência à hipercoagulabilidade e aumento do risco de trombose. Nas gestantes com distúrbios hipertensivos, principalmente na pré-eclâmpsia (PE), este risco está aumentado. Há sugestão de aumento da geração de trombina, ativação do sistema do complemento e liberação de fatores antiangiogênicos. Há evidências de alteração no número total de plaquetas e nos índices plaquetários, volume plaquetário médio (VPM) e fração de plaquetas imaturas (IPF), da geração de trombina e do complexo de ataque a membrana solúvel(sC5b9). A IPF tem sido sugerida como um índice sensível para monitorar mudanças na produção e destruição plaquetária. Objetivo: Avaliar o sistema plaquetário e o sistema do complemento em pacientes com PE comparadas com gestantes normotensas. Material e Método: Estudo transversal. A amostra constituiu-se de pacientes normoensas (NT), com SPE e hipertensão gestacional sem proteinúria patológica (HGsP) que recebem assistência em Hospital Universitário. A seleção foi aleatória, de acordo com a chegada ao Centro Obstétrico e assinatura do Termo de Consentimento Livre e Esclarecido. Número de plaquetas e índices plaquetários foram obtidos pelos contadores automatizados XE-5000 e XN- 3000 (Sysmex Corporation, Roche, Kobe, Japão). Amostras de plasma e soro foram congeladas à -80°C para posterior dosagens da fração solúvel do componente final do sistema do complemento (sC5b9) por ELISA. Resultados: Participaram do estudo, 111 pacientes divididas em 3 grupos (SPE, HGsP e NT com 47, 30 e 34 gestantes, respectivamente). Os resultados estão apresentados na sequência SPE, HGsP e NT. O VPM foi 12,1±1,6, 11,5±1,2 e 10,8±0,99 fL (P<0,001); a IPF foi 7,4 (1,9-21,8),6,8(2,4-17) e 4,9(1,3-9,7)% (P=0,004); o número de plaquetas foi 199.127±52.864, 225.827±80.728 e 240.323±54.321/uL (P=0,012). O sC5b9 foi 1040 (706-1433),1221 (849-1771), 1471 (1085-1986) ng/mL (P=0,023). Conclusão: O VPM e a IPF estão aumentados nas pacientes com SPE em relação aos controles e a contagem total de plaquetas diminuídas. O sC5b9 estava aumentado no grupo controle em relação a SPE. Os controles e as pacientes do grupo HGsP tiveram os níveis de sC5b9 semelhantes. Não ocorreu associação entre os índices plaquetários e o sC5b9. Os parâmetros VPM e IPF são considerados índices de rápida obtenção, baixo custo e de fácil acesso em hospitais que utilizam tecnologia avançada para hemograma, e pelo exposto justifica-se sua introdução na assistência clínica de gestantes, pois podem ser úteis na triagem para auxílio no diagnóstico precoce de SPE. São necessários mais estudos para entender a ativação do sistema do complemento na gestação e na SPE e a interação entre as plaquetas e a via do complemento.Submitted by PPG Medicina e Ciências da Saúde (medicina-pg@pucrs.br) on 2022-09-14T13:11:55Z No. of bitstreams: 1 Tese Dani 1808 versão finalok.pdf: 12165581 bytes, checksum: f551f760c001e51fedc87430b1257497 (MD5)Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2022-09-26T14:46:10Z (GMT) No. of bitstreams: 1 Tese Dani 1808 versão finalok.pdf: 12165581 bytes, checksum: f551f760c001e51fedc87430b1257497 (MD5)Made available in DSpace on 2022-09-26T15:00:55Z (GMT). No. of bitstreams: 1 Tese Dani 1808 versão finalok.pdf: 12165581 bytes, checksum: f551f760c001e51fedc87430b1257497 (MD5) Previous issue date: 2022-05-30Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESapplication/pdfhttps://tede2.pucrs.br/tede2/retrieve/185566/TES_DANIELA_MORAES_CONFIDENCIAL.pdf.jpgporPontifícia Universidade Católica do Rio Grande do SulPrograma de Pós-Graduação em Medicina e Ciências da SaúdePUCRSBrasilEscola de MedicinaGestaçãoPré-EclâmpsiaFração de Plaquetas ImaturasSistema do ComplementoPregnancyPreeclampsiaImmature Platelet FractionComplement SystemCIENCIAS DA SAUDE::MEDICINAAvaliação de aspectos da função plaquetária e do sistema do complemento na hipertensão gestacionalinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisTrabalho será publicado como artigo ou livro60 meses26/09/2027-721401722658532398500500500600-224747486637135387-9693694523087866273590462550136975366info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da PUC_RSinstname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)instacron:PUC_RSTHUMBNAILTES_DANIELA_MORAES_CONFIDENCIAL.pdf.jpgTES_DANIELA_MORAES_CONFIDENCIAL.pdf.jpgimage/jpeg4129https://tede2.pucrs.br/tede2/bitstream/tede/10487/4/TES_DANIELA_MORAES_CONFIDENCIAL.pdf.jpg536b27dfae9675bdde2fd56652cbd927MD54TEXTTES_DANIELA_MORAES_CONFIDENCIAL.pdf.txtTES_DANIELA_MORAES_CONFIDENCIAL.pdf.txttext/plain1563https://tede2.pucrs.br/tede2/bitstream/tede/10487/3/TES_DANIELA_MORAES_CONFIDENCIAL.pdf.txtbb66061bbc059e9fca8dd1ce7257dfedMD53ORIGINALTES_DANIELA_MORAES_CONFIDENCIAL.pdfTES_DANIELA_MORAES_CONFIDENCIAL.pdfapplication/pdf259704https://tede2.pucrs.br/tede2/bitstream/tede/10487/2/TES_DANIELA_MORAES_CONFIDENCIAL.pdf963507a8961e76591097093ee7bc4d83MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-8590https://tede2.pucrs.br/tede2/bitstream/tede/10487/1/license.txt220e11f2d3ba5354f917c7035aadef24MD51tede/104872022-09-26 20:00:18.793oai:tede2.pucrs.br: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Biblioteca Digital de Teses e Dissertaçõeshttp://tede2.pucrs.br/tede2/PRIhttps://tede2.pucrs.br/oai/requestbiblioteca.central@pucrs.br||opendoar:2022-09-26T23:00:18Biblioteca Digital de Teses e Dissertações da PUC_RS - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)false
dc.title.por.fl_str_mv Avaliação de aspectos da função plaquetária e do sistema do complemento na hipertensão gestacional
title Avaliação de aspectos da função plaquetária e do sistema do complemento na hipertensão gestacional
spellingShingle Avaliação de aspectos da função plaquetária e do sistema do complemento na hipertensão gestacional
Moraes, Daniela
Gestação
Pré-Eclâmpsia
Fração de Plaquetas Imaturas
Sistema do Complemento
Pregnancy
Preeclampsia
Immature Platelet Fraction
Complement System
CIENCIAS DA SAUDE::MEDICINA
title_short Avaliação de aspectos da função plaquetária e do sistema do complemento na hipertensão gestacional
title_full Avaliação de aspectos da função plaquetária e do sistema do complemento na hipertensão gestacional
title_fullStr Avaliação de aspectos da função plaquetária e do sistema do complemento na hipertensão gestacional
title_full_unstemmed Avaliação de aspectos da função plaquetária e do sistema do complemento na hipertensão gestacional
title_sort Avaliação de aspectos da função plaquetária e do sistema do complemento na hipertensão gestacional
author Moraes, Daniela
author_facet Moraes, Daniela
author_role author
dc.contributor.advisor1.fl_str_mv Figueiredo, Carlos Eduardo Poli de
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/7183837354797239
dc.contributor.advisor-co1.fl_str_mv Munhoz, Terezinha Paz
dc.contributor.advisor-co1Lattes.fl_str_mv http://lattes.cnpq.br/8174437987130152
dc.contributor.authorLattes.fl_str_mv http://lattes.cnpq.br/8186156084479821
dc.contributor.author.fl_str_mv Moraes, Daniela
contributor_str_mv Figueiredo, Carlos Eduardo Poli de
Munhoz, Terezinha Paz
dc.subject.por.fl_str_mv Gestação
Pré-Eclâmpsia
Fração de Plaquetas Imaturas
Sistema do Complemento
topic Gestação
Pré-Eclâmpsia
Fração de Plaquetas Imaturas
Sistema do Complemento
Pregnancy
Preeclampsia
Immature Platelet Fraction
Complement System
CIENCIAS DA SAUDE::MEDICINA
dc.subject.eng.fl_str_mv Pregnancy
Preeclampsia
Immature Platelet Fraction
Complement System
dc.subject.cnpq.fl_str_mv CIENCIAS DA SAUDE::MEDICINA
description Introduction:Hypertensive disorders are one of the most frequent complications of pregnancy, being responsible for a high rate of maternal-fetal death. Preeclampsia Syndrome (PES) is characterized by elevated blood pressure and pathological proteinuria after the 20th week of gestation, and may have outcomes such as HELLP syndrome, eclampsia, preterm pregnancy and restricted intrauterine growth. Imbalance in hemostatic mechanisms can occur during pregnancy with a tendency for hypercoagulability and increased thrombosis risk. In pregnant women with hypertensive disorders, especially in preeclampsia (PE), this risk is increased. There is a suggestion of increased thrombin generation, activation of the complement system and release of antiangiogenic factors. Pregnant women with hypertensive disorder, especially preeclampsia, show alterations in platelet indexes, mean platelet volume (MPV), immature platelet fraction (IPF), thrombin generation and soluble membrane attack complex(sC5b9). IPF has been suggested as a sensitive index for monitoring changes in platelet production and destruction. Objectives: To evaluate IPF, MPV and C5b9 in patients diagnosed with a gestational hypertensive disorders (GHD). Material and method: A cross-sectional study was conducted in pregnant women with normotensive pregnancy (NP), preeclampsia syndrome (PES) or non-proteinuric hypertensive pregnancy (nPHP). Following ethical approval and written informed consent, samples were collected. Platelet count and indexes were measured by fluorescent flow cytometry by automated counters XE-5000 and XN-3000 (Sysmex Corporation, Roche, Kobe, Japan). Plasma and serum samples were frozen at -80°C for laterdetermination of sC5b9 by ELISA. Results: A total of 111 pregnant women were included and divided into three groups: PES, nPHP and NP with 47,30 and 34 women, respectively. Results are presented in the following sequence: PES, nPHP and NP. MVP was 12.18±1.6, 11.5±1.2 and 10.8±0.99 fL (P<0.001);IPF was 7.4 (1.9-21.8), 6.8(2.4-17) and 4.9(1.3-9.7)% (P=0.004); platelets counts were 199127±52864, 225827±80728 and 240323±54321 /uL (P=0.012). sC5b9 was 1040 (706-1433), 1221(849-1771) and 1471(1085-1986) ng/mL (P=0.023). Conclusion: MPV and IPF are increased and platelet count is decreased in patients with SPE compared to controls. sC5b9 was increased in controls in comparison with SPE. Controls and HGsP group had similar sC5b9 levels. There was no association between platelet indexes and sC5b9. MPV and IPF are measurements can be obtained quickly, have low-cost and are easily accessible in hospitals that use advanced technology for blood counts. It is suggested that these markers could be used in daily routine as an additional tool in the management of pregnant women. More studies are needed to understand the activation of the complement system in pregnancy and PES and the interaction between platelets and the complement pathway.
publishDate 2022
dc.date.accessioned.fl_str_mv 2022-09-26T15:00:55Z
dc.date.issued.fl_str_mv 2022-05-30
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