Сучасні маркери прогнозування прееклампсії
DOI:
https://doi.org/10.15574/HW.2019.146.77Ключові слова:
прееклампсія, прогнозування, вагітність, материнська смертність, гіпертензія, біохімічні маркериАнотація
Гіпертензивні розлади під час вагітності є однією з основних причин материнської і перинатальної захворюваності і смертності в усьому світі. Разом з передчасним відшаруванням плаценти, затримкою росту плода і невиношуванням вагітності прееклампсія належать до «великих акушерських синдромів» (Great Obstetrical Syndromes), пов’язаних з патологією плацентації. Понад 75% материнської смертності припадає на чотири причини: прееклампсія, сепсис, кровотечі і екстрагенітальні захворювання. Згідно з ВООЗ, тяжка прееклампсія ускладнює від 2 до 8% всіх вагітностей і в структурі прямих причин материнської смертності, як і раніше, посідає 2-е місце і становить близько 14%. Прееклампсія залишається однією з основних причин захворюваності новонароджених (640–780‰) та перинатальної смертності (18–30‰).
Пошуки клініко-діагностичних маркерів, які б дали можливість з високою ймовірністю та специфічністю визначити термін виникнення прееклампсії, тривають. Жоден з відомих сьогодні маркерів поодинці не здатен достовірно прогнозувати розвиток прееклампсії. Прогностична модель – це альтернативна основа для клінічної практики, що дає можливість для прогнозування результатів і вчасного прийняття рішень щодо їхнього поліпшення.
Проведено огляд практичних рекомендацій основних світових профільних організацій щодо використання прогностичних моделей. Досліджено позицію ключових профільних організацій з питання прогнозування прееклампсії на сучасному етапі та залучення у цьому прогностичних моделей. Зібрано дані проведених досліджень щодо використання біохімічних маркерів та їхніх комбінацій у прогнозуванні розвитку прееклампсії. Вивчено найбільш перспективні прогностичні моделі, у яких використовують анамнестичні, інструментальні дані та результати біохімічних маркерів. Наведено прогностичну цінність та специфічність цих моделей для визначення ранньої та пізньої маніфестації прееклампсії, а також можливого їхнього впровадження у клінічну практику.
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