Despite numerous studies, the pathogenesis of the premature abortion development is not fully disclosed. There is also no generally accepted theory that would explain the whole variety of violations and allowed to substantiate the effective complex of treatment and preventive measures for the prevention of reproductive losses and the obstetric complications remote development. The purpose of the study was to study the features of the «proteinase- inhibitor proteinase» system state by detecting the activity of neutrophil elastase and plasma concentrations of proteinase inhibitors α1-antitrypsin and α2-macroglubulin in women with different periods of pregnancy termination. Material and methods. 227 pregnant women who were admitted to the Kharkiv city perinatal center were examined, 190 of them had clinical signs of premature pregnancy termination in the period of gestation of 23-36 weeks. Formation of clinical groups was carried out depending on the term of pregnancy in the form of premature and timely birth. The criteria for including women into groups were the following: young reproductive age, single-pregnancy, absence of gestosis, acute and chronic gynecological and somatic diseases. Detection of preterm labor was carried out in the presence of abdominal pain syndrome and structural changes in the cervix. Conclusions. The disturbance of the dynamic equilibrium between the activity of endogenous proteolytic enzymes and the content of their inhibitors, which is confirmed by the reliable (p≤ 0.001) increase in the activity of neutrophil elastase, by an average of 46%, together with a 36% increase in plasma α1-antitrypsin plasma levels and a decrease in the concentration of α2-macroglobulin on 30% was observed in women with preterm labor in the period of 23-27 weeks in relation to women with the physiological course of pregnancy, which ended with childbirth without complications in the period of 38-41 weeks. The change in the rates was less pronounce in women with preterm labor in the period of 28-36 weeks in relation to women in the control group: an increase in neutrophil elastase was an average of 25% (p <0.001) and plasma concentration α1-antitrypsin 21% (p = 0.006) with a decrease concentration of α2-macroglobulin by 13% (p = 0.142). The tension of proteolytic processes was most pronounced in the direction of the proteinase activity prevalence in women with preterm labor in the period of 26-30 weeks, which was confirmed by the probable (p≤0,014) increase in the ratio of the activity of neutrophil elastase to the sum of concentrations of inhibitors of α1-AT and α2- MG on average 32%. The imbalance in the «proteinase- inhibitors of proteinase» system is one of the links in the pathogenesis of non-pregnancy and can contribute in combination with other complications.
Full text: PDF (Eng) 181K