| Objective: Preeclampsia is a common obstetric disease which seriously endangers maternal and fetal health.In preeclampsia,the activation of coagulation and fibrinolysis system leads to a hypercoagulable state.As an essential factor in the process of hemostasis,the role of VWF in preeclampsia has not been fully clarified.And this study detected the level of VWF antigen and ADAMTS-13 as the cleaving protease of VWF multimers,the adhesion between VWF and EVs,the activity of anticoagulant AT and the level of t-PAIC which acted as the marker of fibrinolytic system in the plasma of preeclampsia patients,healthy pregnant or non-pregnant women.Then we compared the difference of these indexes’ level in three groups before delivery as well as the difference of these indexes’ level before and after delivery in preeclampsia and pregnant women respectively.We further analyzed the correlation between VWF and its adhesion with EVs and AT or t-PAIC.We aimed to explore the level and clinical significance of VWF associated indexes in preeclampsia,which may contribute to the evaluation of condition of preeclampsia in clinical practice.Method: A total of 57 preeclampsia patients,32 healthy pregnant women and 22 normal non-pregnant women were selected from January 2018 to January 2019 in the department of gynecology and obstetrics of Tianjin Medical University General Hospital.The peripheral blood was taken at the first admission before delivery and 1 day or 3 to 4 after delivery in preeclampsia patients and healthy pregnant women to detect the level of VWF:Ag,ADAMTS-13,the adhesion between VWF and total EVs or platelet-derived EVs,AT activity and t-PAIC which were also detected in the nonpregnant women during the non-menstrual period.One-way ANOVA or rank sum test were used to compare differences of the detected indexes level in three groups and the change before and after delivery.Spearman correlation analysis was used to evaluate the correlation among the indexes.Results: 1.The antepartum plasma level of VWF antigen in healthy pregnant women was significantly higher than that of non-pregnant women,both of which were significantly lower than that of preeclampsia patients.When compared with that before delivery,the level of VWF antigen 3 to 4 days after delivery was higher in healthy pregnant women,but did not significantly change in preeclampsia.2.The antepartum plasma level of ADAMTS-13 in healthy pregnant women did not significantly change when compared with that of non-pregnant women,both of which were significantly higher than that of preeclampsia patients.And the ratio of antepartum VWF antigen and ADAMTS-13 in healthy pregnant women did not significantly change when compared with that of non-pregnant women,both of which were significantly higher than that of preeclampsia patients.The level of ADAMTS-13 1 day after delivery in healthy pregnant women was significantly lower than that before delivery and there was no significant difference 3 to 4 days after delivery when compared with that before delivery or 1 day after delivery.However,there was no significant change of the level of ADAMTS-13 between that before delivery,1 day or 3 to 4 days after delivery in preeclampsia patients.3.The antepartum plasma level of the adhesion between VWF and total EVs in healthy pregnant women was significantly higher than that of non-pregnant women,both of which were significantly lower than that of preeclampsia patients.When compared with that before delivery,the level of the adhesion between VWF and total EVs was significantly lower 1 day or 3 to 4 days after delivery and there was no significant difference 3 to 4 days after delivery when compared with that 1 day after delivery both in healthy pregnant women and preeclampsia patients.4.The antepartum plasma level of the adhesion between VWF and platelet-derived EVs in healthy pregnant women did not significantly change when compared with that of non-pregnant women,both of which were significantly lower than that of preeclampsia patients.When compared with that before delivery,the level of the adhesion between VWF and platelet-derived EVs was significantly lower 1 day or 3 to 4 days after delivery and there was no significant difference 3 to 4 days after delivery when compared with that 1 day after delivery both in preeclampsia and healthy pregnant women.5.The antepartum plasma level of AT activity in healthy pregnant women did not significantly change when compared with that of non-pregnant women,both of which were significantly higher than that of preeclampsia patients.When compared with that before delivery,the level of AT activity 3 to 4 days after delivery in healthy pregnant women was significantly lower,but was significantly higher in preeclampsia patients.6.The antepartum plasma level of t-PAIC in healthy pregnant women did not significantly change when compared with that of non-pregnant women,both of which were significantly lower than that of preeclampsia patients.When compared with that before delivery,the level of t-PAIC 3 to 4 days after delivery did not significantly change both in healthy pregnant women and preeclampsia patients.7.There is positive correlation between the plasma level of VWF antigen and t-PAIC in the preeclampsia patients before delivery.Conclusion: On the basis of vascular endothelial injury,which is the essential process in the pathophysiology of preeclampsia,the balance between coagulation and fibrinolysis system is disrupted which leads to the hypercoagulable state.VWF acts as not only a marker of endothelial injury,but also an important factor in the hemostasis.The releasement of VWF by the injuried vascular endothelial cells with a large amount along with the impaired scavenging ability as a result of relative deficiency of ADAMTS-13 lead to the existence of VWF with the high level in preeclampsia.VWF involving in the hemostasis process may cause the decrease of the activity of anticoagulant AT and the activation of fibrinolytic system,which may further lead to the onset of preeclampsia and its hypercoagulable complications. |
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