Alterations Of Plasma SEPCR And TAFI Levels In Preeclampsia

Objective: Preeclampsia (preeclampsia, PE) is a pregnancy-specificdisease that may develop multiple organ dysfunction or failure. It is reportedthat preeclampsia is one of the major causes of perinatal and maternal deaths.The etiology of preeclampsia is not completely known, but one of the mostcommon histopathologic alterations seen in placentas with preeclampsia isvarious degrees of thrombosis, recent studies considered that the occurrenceof preeclampsia may be related to abnormal coagulation and fibrinolysissystem. As a coagulation indicator soluble endothelial protein C receptor(sEPCR) can be combined with protein C (PC) thereby inhibiting theactivation of protein C and the coagulation activity of activated protein C(APC). Therefore it can promote the clotting process and the generation ofthrombin. Thrombin-activated fibrinolysis inhibitor (TAFI) is an importantfibrinolysis marker in human that can be converted by thrombin andthrombin-thrombomodulin complex into its active form. After activated,TAFI can suppress fibrinolysis and down-regulate the fibrinolysis system,therefore promote thrombosis. By detecting plasma sEPCR and TAFIconcentrations in preeclamptic women, this study aims to explore weatherthe changes of biomarkers in coagulation and fibrinolysis system is related tothe occurrence and severity of preeclampsia.Methods:1According to the diagnostic criteria of preeclampsia,90pregnantwomen were collected from the second hospital of HeBei medical university.Among the90women,30pregnant women were suffering from severepreeclampsia (SPE),30pregnant women with mild preeclampsia (MPE), and30normal pregnant women were randomly selected as the controls.26ml peripheral blood was collected from the study cases(pre-treatment) and the controls within24hours after admission.3ml of them, which was separated plasma by2500rpm for10minutes, was stored at-70℃refrigerator for assaying sEPCR and TAFI levels, the other3ml of the bloodwas used to assay the levels of coagulation indicators and D-Dimer. Afterdelivery, sample of placenta tissue,1x1x1cm in size, was taken. The tissueswere fixed in4%formalin after rinsing for HE staining.3Determine the levels of sEPCR and TAFI by the method ofenzyme-1inked immunosorbent assay (ELISA). Plasma PT, APTT, Fib andD-Dimer levels were all detected in the laboratory of our hospital. Theplacental tissues of thrombosis was detected by HE staining and observedunder microscope. Indicators such as weight, age, height and blood pressurefrom each subject were all recorded.4All of the data were analyzed by the software SPSS13.0．Results：1Plasma levels of sEPCR were gradually decreased in SPE group, MPEgroup and control group (P<0.05, separately), it showed significant differenceamong the three groups. Plasma levels of TAFI in SPE group were significanthigher than MPE group and control group (P<0.05, separately), it showed nosignificant difference between control and MPE groups (P>0.05).2Plasma levels of PT and APTT were gradually increased in SPE group,MPE group and control group, but it showed no significant difference amongthe three groups (P>0.05, separately).3SPE group and MPE group had significant higher plasma Fib levelsthan control group (P<0.05, separately), but it showed no significantdifference between MPE and SPE groups (P>0.05). Plasma levels ofD-Dimer in SPE group, MPE group and control group were graduallydecreased, it showed significant difference among the three groups (P<0.05,separately).4Plasma sEPCR levels in preeclamptic patients (SPE and MPE) werepositively correlated with plasma TAFI、Fib and D-Dimer levels (P<0.05,separately), no significant correlation with plasma PT and APTT levels(P>0.05, separately). Plasma TAFI levels were positively correlated with plasma Fib and D-Dimer levels (P<0.05，separately), while it had nosignificant correlation with plasma PT and APTT levels (P>0.05, separately).Plasma sEPCR levels in control group were positively correlated withplasma Fib levels (P<0.05), while it had no significant correlation withplasma TAFI, PT, APTT and D-Dimer levels (P>0.05，separately). PlasmaTAFI levels had no significant correlation with plasma PT, APTT, Fib andD-Dimer levels (P>0.05, separately).5There were17cases of placental tissues with thrombosis in SPEgroup (30cases)(the rate is56.7%),9cases of placental tissues withthrombosis in MPE group (30cases)(the rate is30.0%), and only1case ofplacental tissues with thrombosis in control group (30cases)(the rate is3.3%). The percentage of placenta with thrombosis is gradually increased incontrol group, MPE group and SPE group, it showed significant differenceamong the three groups (P<0.05, separately).Conclusion:1Plasma levels of sEPCR and TAFI were significantly higher withPreeclampsia patients than control group, suggesting that both of them wereinvolved in the pathological changes of preeclampsia, further validation thatthere was certain correlation between the coagulation-fibrinolysis system andpreeclampsia.2The plasma level of sEPCR was particularly higher in severepreeclampsia, and suggesting that the sEPCR level was better in reflectingseverity of preeclampsia.3The percentage of placental tissues with thrombosis was graduallyincreased in control group, mild preeclampsia group and severe preeclampsiagroup, suggesting that preeclampsia patients have more potential forthrombophilia.