Dissertation
Dissertation > Medicine, health > Obstetrics and Gynaecology > Obstetrics > Pathological pregnancy ( abnormal pregnancy ) > Complications of pregnancy

Changes of the Metalloprotease That Cleaves Von Willebrand Factor in Women During Normal Pregnancy and Other Diseases Like Gestational Hypertension

Author ShuMingMing
Tutor ChenYouGuo
School Suzhou University
Course Obstetrics and Gynaecology
Keywords vWF-cp ADAMTS-13 pregnancy Gestational hypertension preeclampsia Systemic lupus erythematosus Thrombotic thrombocytopenic purpura
CLC R714.25
Type Master's thesis
Year 2011
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Objective: The present study aimed to evaluate the diversify of the plasma levels of the vWF colla-gen-binding activity during normal pregnancy and pregnancy with Gestational hypertension , Systemic lupus erythematosus or Thrombotic thrombocytopenic purpura.We also want to investigate the relationship between blood coagulation function , low birth weight and the plasma levels of the vWF colla-gen-binding activity.Methods: Our research objects were composed of two parts, firstly, one hundred women during normal pregnancy has been consented to participate in this study. They had regular inspection in the first affiliated hospital of Soochow university ever since the first trimester during Apr 1, 2009 to May 31, 2009 .The participants were all informed to know the research project and agreed to participate voluntarily. We collected the serum of these women during three trimesters and follow-up the outcomes of these people. Secondly, we collected the serum of patients who were clinically diagnosed Gestational hypertension, Systemic lupus erythematosus or Thrombotic thrombocytopenic purpura. We used a fluorescence resonance energy transfer (FRET) assay for the measurement of ADAMTS13 in human plasma. We used the software of EpiData 3.2 to establish a database. Two people input data alternately. We used the software of SAS 9.1 to do the statistical analysis.Results:1. Diversify of the plasma levels of the vWF colla-gen-binding activity of normal pregnancy women during three trimesters.The ADAMTS13 activity during the first trimester(median 94.3 days) is 80.6%±19.9%(median±Interquartile), ADAMTS13 activity during the second trimester(median 161.4days) is 67.8%±18.2%, ADAMTS13 activity during the third trimester(median 232.2days) is 57.4%±14.1%. There was significant difference in plasma ADAMTS13 activity between three trimesters(P<0.001). Thus, the ADAMTS13 activity decreased progressively as from the period of first trimester up to the third trimester.2. Diversify of the plasma levels of the vWF colla-gen-binding activity of primigravidae and multigravidae during three trimesters.There are 70 primigravidae and 17 multigravidae during 87 research objects. The ADAMTS13 activity of primigravidae during three trimesters are respectively 74%±11.3%, 63.9%±9.7% and 54.2%±7.2%. The ADAMTS13 activity of multigravidae during three trimesters are respectively 88.3%±4.9%, 79.3%±6.4% and 72.5%±4.8%. Primigravidae presented mildly lower levels of ADAMTS13 activity than multigravidae between first trimester up to the third trimester of pregnancy (P < 0.001).3. The relationship between blood coagulation function and the plasma levels of the vWF colla-gen-binding activity.The level of Prothrombin time(PT), Actived partial thromboplastin time(APTT), Thrombin time(TT), Fibrinogen(FBG), Anti-thrombinⅢ(AT-Ⅲ) during the third trimester are not associated with the levels of ADAMTS13 activity(r=0.02, P=0.857; r=-0.19, P=0.120; r=0.21, P=0.087; r=0.16, P=0.212; r=-0.14, P=0.268). 4. The relationship between low birth weight and the plasma levels of the vWF colla- gen-binding activity.There were 10 mothers gave birth to low birth weight babies during 87 research objects. The ADAMTS13 activity of this group of mothers are 58.3%±12.6%, compared to 57.7%±9.6% of normal birth weight group.There was not significant difference between these two groups(P=0.869).5. Diversify of the plasma levels of the vWF colla-gen-binding activity during pregnancy with Gestational hypertension.There were 4 women developed hypertension during 87 research objects. In addition, we collected another 43 hypertension patients in the wards. During these 47 hypertension patients, we have 11 Gestational hypertension, 5 mild preeclampsia, 24 Severe pree- clampsia and 7 Chronic hypertension with preeclampsia. The ADAMTS13 activity of these groups are respectively 57.6%±11.2%, 55.3%±11.7%, 46.1%±7.8% and 58.7%±9.4%. There was significant difference in plasma ADAMTS13 activity between the preeclampsia and the healthy pregnant groups (P<0.001). There was not significant difference in plasma ADAMTS13 activity between other groups and the healthy pregnant group(P=0.927; P=0.571; P=0.827).6. Diversify of the plasma levels of the vWF colla-gen-binding activity during pregnancy with Systemic lupus erythematosus.There were 2 women diagnosed pregnant with Systemic lupus erythematosus during 87 research objects. In addition, we collected another 8 pregnant women with SLE in the wards. There was significant difference in plasma ADAMTS13 activity between the SLE and the healthy pregnant groups (median43.0%±14.5% and 57.9 %±9.6% respectively; P=0.010). There was not significant difference in plasma ADAMTS13 activity between the SLE and pregnancy with Gestational hypertension (median43.0%±14.5% and 43.0%±7.8% respectively; P=0.215).7. Diversify of the plasma levels of the vWF colla-gen-binding activity during pregnancy with Thrombotic thrombocytopenic purpura.The ADAMTS13 activity of the 3 TTP patients we collected in the wards were all 0%. The ADAMTS13 activity of TTP is obviously lower than the healthy pregnant group, hypertension group and SLE group.Conclusion:1. ADAMTS13 activity decreased progressively as from the period of first trimester up to the third trimester.2. Primigravidae presented mildly lower levels of ADAMTS13 activity than multigravidae between first trimester up to the third trimester of pregnancy.3. The level of Prothrombin time(PT), Actived partial thromboplastin time (APTT), Thrombin time(TT), Fibrinogen(FBG), Anti-thrombinⅢ(AT-Ⅲ) during the third trimester are not associated with the levels of ADAMTS13 activity.4. There was not significant difference in plasma ADAMTS13 activity between the mothers who gave birth to low birth weight babies and the healthy pregnant groups.5. There was significant difference in plasma ADAMTS13 activity between the preeclampsia and the healthy pregnant groups. There was not significant difference in plasma ADAMTS13 activity between other kinds of hypertension patients and the healthy pregnant group.6. There was significant difference in plasma ADAMTS13 activity between the SLE and the healthy pregnant groups.7. There was significant difference in plasma ADAMTS13 activity between the TTP and the healthy pregnant groups, the SLE group and hypertension patients.

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