Lipoprotein A and fibrinolytic parameters in normal and preeclamptic pregnancies

الملخص EN

Normal pregnancy is a physiological condition of balanced hypercoagulation.

However, in preeclamptic pregnancies, the coagulation and fibrinolytic cascades are highly activated, accompanied by endothelial dysfunction.

Lipids may interfere with coagulation and cause endothelial dysfunction.

Lipoprotein-a (Lp-a) is a circulating lipoprotein particle, has been found to enhance blood coagulation by competing with plasminogen (PLC) for its binding sites on fibrin clots and endothelial cells.

Therefore, we aimed to evaluate the Lp-a and fibrinolytic parameters (plasminogen, fibrinogen, and D-dimer) in normotensive and preeclamptic pregnant women and non-pregnant women, as well as to assess any association with severity of the disease.

The study was carried out in 52 women, age range 17-38 years, including 10 normotensive pregnant women, 31 preeclamptic women (13 with mild preeclampsia (MPE) and 19 with severe preeclampsia (SPE) and 10 non-pregnant women as control group, the mean gestational age for MPE, SPE and normotensive pregnant women were 35.5±3.1, 36.0±3.4 and 36.5±1.4 weeks, respectively.

Lipoprotein A (Lp-a) was significantly increased in MPE (40.7±12.2 mg/dL) and SPE (90.8±19.6 mg/dL) compared with normotensive pregnant women (12±5.9 mg/dL) and controls (10±5 mg/dL).

Also, Lp(a) was significantly increased with severity of the disease (p<0.0001).

As regard fibrinolytic parameters: the mean value of PLG was 102.8±15.2% in non-pregnant women, 108.4±16.3% in normal pregnancy, 103.35^16.0% in MPE and 108.4±18.4% in SPE.

There was insignificant change between pregnant and nonpregnant women, between normal and hypertensive pregnancy and between MPE and SPE.

Fibrinogen level was significantly increased in pregnant women (normotensive and hypertensive) in comparison to controls (4.81±0.95 g/l in normal pregnancy, 4.77± 1.64 g/l in MPE and 4.53±L12 g/l in SPE vs 3.18±0.82g/l in controls).

Insignificant change occurred in preeclamptic women when compared with normotensive pregnant women and between MPE and SPE.

D-dimer was significantly increased in pregnant normotensive and preeclamptic women in comparison to controls and between normotensive and preeclamptic pregnant women but insignificant between MPE and SPE.

Conclusion: Lp(a) levels are elevated in preeclampsia and associated with severity of the disease.

So, it may serve as a marker of the pathogenic process: Abnormalities in fibrinolytic parameters (fibrinogen and D-dimer) indicates activation of fibrinolysis in response to intravascular coagulation which may be prevented from reaching its full potential.

On the other hand, the absence of significant changes in plasminogen may not be mediated by tissue plasminogen activator (tPA) but by urokinase, whose interaction with PLG is not effected by Lp-a.