İtibar EMİNLİ, MUSTAFA KARA, Ercan YILMAZ, Tufan ÖĞE, Cüneyt EVRÜKE

Habitüel abortuslu hastalarda trombofilinin araştırılması

Amaç: Bu çalışmada tekrarlayan gebelik kayıpları olan hastalarda trombofıli faktörlerinin etkisini araştırmayı amaçladık Materyal ve Metod: Çalışmaya Aralık 2004- Mart 2006 tarihleri arasında Çukurova Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalına habitüel abortus tanısı ile başvuran hastalar dahil edilmiştir.Hasta grubu 66, kontrol grubu 74 kişiydi.Kontrol grubunda aynı yaş grubunda, habitüel abortus öyküsü ve sistemik hastalığı olmayan, tromboz açısından bireysel ve ailesel öyküsü olmayan, herhangi bir obstetrik komplikasyon gelişmeden vaginal yolla veya sezaryenle doğum yapmış sağlıklı 74 kadın mevcuttu. Sonuç: Hasta grubunun yaş ortalaması 29,3±5.4, kontrol grubunun yaş ortalaması ise 27.4±5,2 olup iki grup arasındaki yaş farkı istatiksel olarak anlamlı değildi.Çalışma sonucunda habitüel abortus ve kontrol grupları arasında Protein C ve Antitrombin III (AT III) değerleri açısından anlamlı fark bulunurken, Faktör V Leiden, Protrombin G20210A, MTHFR C677 T mutasyonları ve Protein S değeri arasındaki fark istatiksel olarak anlamsız bulunmuştur. Tartışma: Maternal trombofililer (Faktör V Leiden,Protrombin G20210A, MTHFR C677 T mutasyonu, Protein C, Protein S ve AT III eksiklikleri) obstetrik açıdan önemlidir. Habitüel abortuslu hastalarda çalışmaların çoğu, Faktör V Leiden ve vasküler plasenta! yetmezlik arasında sıkı bir bağ olduğunu göstermektedir. Sonuç olarak, Antitrombin III ve Protein C hasta grubunda daha düşük düzeylerde bulunmuş ve bu fark istatiksel olarak anlamlı kabul edilmiştir. Protein S, Faktör VLeiden, Protrombin G20210A ve MTHFR C677T mutasyonları açısından hasta ve kontrol grubu arasında anlamlı bir fark bulunamamıştır.

Anahtar Kelimeler:

Düşük, tekrarlayan, Faktör V leiden, Antitrombin III, Yaş dağılımı, Protein C, Protein S, Protrombin, Değerlendirme çalışmaları

Evaluation of trombophilia in habitual abortion cases

Objective: We aimed to research the effect of the thrombophilia factors in the of habitual abortion. cases Material and Methods: The patients who participated to the Çukurova University Faculty of Medicine, Department of Gynecology and Obstetrics between in December 2004 to March 2006 with the diagnosis of habitual abortion were included to the study. The number of the patient group was 66 and the control group was 74. There were 74 healthy women in the control group, at the same age,without the story of habitual abortion and systemic disease and without familial and individual history of thrombosis and delivered by vaginal way or by caeseraean without developing any obstetric complication. Results: The average age of the patient group was 29.3 ± 5.4, the control group was 27.4 ± 5.2 years and the difference between the two groups were not statistically significant. The difference of the Protein C and Antitrombin III values between habitual abortion and control groups was found significant,while the differences in terms of values of Factor VLeiden, Protrombin G20210A, and MTHFR C677 T mutations and Protein S values was not statistically significant at the end of the study. Conclusion: Maternal thrombophilias (Factor V Leiden,Protrombin G20210A, MTHFR C677 T mutation, Protein C, Protein S and AT III deficiencies) is important in terms of obstetric way. The majority of the studies have shown that a tight link between factor V Leiden and vascular placental insufficiency in the patients with habitual abortion. Finally, in the patient group Antitrombin III and Protein C levels were found lower than the control group and this difference was not statistically significant. There was not a significant difference between patient and control groups in terms of Protein S, Factor V Leiden,Protrombin G20210A and MTHFR C677 T mutations.

Keywords:

Abortion, Habitual, Factor V leiden, Antithrombin III, Age Distribution, Protein C, Protein S, Prothrombin, Evaluation Studies,

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1.Clark DA, Chauat G. What do we know about spontaneous abortion mechanisms? Am JReprod Immunol, 1989;( 19): 28-37
2.Wilcox AH, Weinberg CR, O'Connor JF. incidence of early loss of pregnancy. N.Engl.j Med, 1998; (319) .-189-194
3.Bick RL. Recurrent miscarriage syndrome and infertility caused by blood coagulation protein or platelet defects. Hematol Oncol Clin North Am, 2000; 14(5): 1117-31
4.Preston FE, Rosendaal FR, Walker I.D ,Briet E. ,Berntorp E. , Conard J. et. all. Increased fetal loss in women with heritable thrombophilia. TheLancet, 1996; 348(5):913-916
5.Brigden ML. The hypercoagulable state who how and when to test and treatment. Postgraduate Medicine, 1997; (101)-.5249-5268
6.Blumenfeld Z, Brenner B. Thrombophilia-associated pregnancy wastage. Fertil Steril, 1999;72(5):765-74
7.Donna S, Dizon-Townson, Sanja K, D Ware B, Kenneth W. The factor V Leiden mutationis not a common cause of recurrent miscarriage. J reprod Immunol, 1997; (34): 217-223
8.Ridker PM, Miletich JP, Buring JE, Ariyo AA, Price DT, Manşon JE, et all. Factor V Leiden mutation as a risk factor for recurrent pregnancy loss. Ann Intern Med, 1998; 128 (12 Pt 1): 1000-3
9.AznarJ, Villa P, EspanaF, Estelles A, Grancha S, Falco C. Activated protein C resistance phenotype in patients with antiphospholipid antibodies. JLab Clin Med, 1997; 130 (2):202-8
10.Rai R, Regan L. Thrombophilia and adverse pregnancy outcome. Semin Reprod Med, 2000; 18(4): 369-77
11.Bick RL, Madden J, Heller KB, Toofanian A. Recurrent miscarriage: causes, evaluation, and treatment. Medscape Womens Health, 1998; 3 (3):2
12.Dekker GA, de Vries JIP, Doelitzsch PM, Huijgens PC, Von Blomberg BME et. al. Underlying disorders associated with severe early onset preeklampsia. Am J O Gynecol, 1995; (173): 1042-1048
13.Vincenso S, Vincenso A, Francesco M. The impact of the Factor V Leiden mutatiom on pregnancy. Hum Reprod Update. 2000; 6(3):301-306
14.Foka ZJ, Lambropoulos AF, H.Saravelos, G.B. Kara, A.Karavida, T.Agorastos et. all. Factor V leiden andprothrombin G20210A mutations, but not methylenetetrahydrofolate reductase C677T, are associated with recurrent miscarriages. Hum Reprod, 2000; 15(2):458-62
15.YusoffN.M, Abdullah W.Z, Gazali S, Othman M.S, BabaA.A, Abdullah Net.all The absence of faktör V Leiden mutation in Malays with recurrent spontaneous abortions. Aus NZJ Obstet Gynaecol, 2002;(42):2:164-6
16.Pihusch R, Buchholz T, Lohse P, Rubsamen H, Rogenhofer N, Hasbargen Uet.all. Thrombophilic gene mutations and recurrent spontaneous abortion: prothrombin mutation increases the risk in the first trimester. Am J Reprod Immunol, 2001; 46(2):124-31
17.DilleyA, Bentino C, Hooper WC, Austin H, Miller C, El-Jamil M et.all. Mutations in the faktör V, Protrombin and MTHFR genes are not risk factors for recurrent fetal loss. J Maternal Fetal Neonatal Med. 2002 Mar; 11(3): 176-82 18.Ogasawara MS, Aoki K, Katano K,Ozaki XSuzumoriK Factor XII but not protein C, protein S, Antitrombin III, or Factor XIII is a predictor of recurrent miscarriage. Fertility and Sterility, 2001 May; 75(5): 916-9
19.Agnieszka SM, KrzysztofD, Piotr P, Agnieszka KS.İnherited trombophilia in women with recurrent miscarriages and pregnancy loss in anamnesis
Ginekol Pol. 2008 Sep;79(9):630-4. Review. Polis 20. Norrie G, Farquharson RG, Greaves M.Screening and treatment for heritable trombophilia in pregnancy failure inconsistencies among UK early pregnancy units. Br J Haematol. 2009 Jan;144(2):241-4. Epub 2008 Nov 19