akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLCakusherstvo-53Research ArticleREVIEW ARTICLEНАУЧНЫЙ ОБЗОРPATHOGENETIC MECHANISMS OF THROMBOEMBOLIC COMPLICATIONS OF THE METABOLIC SYNDROME IN PREGNANCYПАТОГЕНЕТИЧЕСКИЕ МЕХАНИЗМЫ ТРОМБОЭМБОЛИЧЕСКИХ ОСЛОЖНЕНИЙ МЕТАБОЛИЧЕСКОГО СИНДРОМА У БЕРЕМЕННЫХХромылевА. В.KhromylevA. V.khromilev@mail.ruМакацарияА. Д.MakatsariyaA. D.ГБОУ ВПО «Первый МГМУ имени И.М. Сеченова» Минздрава РФ, МоскваРоссияState Federal-Funded Educational Institution of Higher Vocational Training I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian FederationRussian Federation201406062016816873Copyright © Khromylev A.V., Makatsariya A.D., 20162016Хромылев А.В., Макацария А.Д.Khromylev A.V., Makatsariya A.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/53

Prevalence of the metabolic syndrome (MS) is growing all over the world, including women of reproductive age. There is evidence that the presence of MS is associated with hypercoagulation, deficiency in the system of fibrinolysis, increase in platelets activity and, as a consequence, an increased risk of thrombosis. Nowadays genetic and metabolic disorders that underlie the relationship between MS and thromboembolic complications are under active study.

Распространенность метаболического синдрома (МС) неуклонно растет во всем мире, в том числе среди женщин репродуктивного возраста. По данным ряда исследований, наличие МС ассоциировано с гиперкоагуляцией, рядом нарушений в системе фибринолиза, повышением активности тромбоцитов и, как следствие, повышенным риском тромбозов. На сегодняшний день активно изучаются генетические и метаболические нарушения, обуславливающие наличие взаимосвязи МС с тромбоэмболическими осложнениями.

МЕТАБОЛИЧЕСКИЙ СИНДРОМОЖИРЕНИЕБЕРЕМЕННОСТЬPREGNANCYТРОМБОФИЛИЯТРОМБОТИЧЕСКИЕ ОСЛОЖНЕНИЯТРОМБОЗmetabolic syndromeobesitypregnancythrombophiliathromboembolic complicationsthrombosisReferencesДедов И.И., Андреева Е.Н., Карпова Е.А. Синдром поликистозных яичников этиология, патогенез, диагностика и лечение: практические рекомендации для врачей. М. 2009; 51 c.Dedov. I.I., Andreeva E.N., Karpova E.A.Sindrom polikistoznyh jaichnikov jetiologija, patogenez, diagnostika i lechenie: prakticheskie rekomendacii dlja vrachej. M. 2009; 51 c.Макацария А.Д., Бицадзе В.О. и др. Антифосфолипидный синдром – иммунная тромбофилия в акушерстве и гинекологии. М. 2013; 485 с.Makacarija A.D., Bicadze V.O. i dr. Antifosfolipidnyj sindrom – immunnaja trombofilija v akusherstve i ginekologii. M. 2013; 485 s.Макацария А.Д., Белобородова Е.В., Баймурадова С.М., Бицадзе В.О. Гипергомоцистеинемия и осложнения беременности. М. 2007.Makacarija A.D., Beloborodova E.V., Bajmuradova S.M., Bicadze V.O. Gipergomocisteinemija i oslozhnenija beremennosti. M. 2007.Макацария А.Д., Пшеничникова Е.Б., Пшеничникова Т.Б., Бицадзе В.О. Метаболический синдром и тромбофилия в акушерстве и гинекологии. М. 2006; 480 с.Makacarija A.D., Pshenichnikova E.B., Pshenichnikova T.B., Bicadze V.O. Metabolicheskij sindrom i trombofilija v akusherstve i ginekologii. M. 2006; 480 s. Alessi M.C., Juhan-Vague I. Metabolic syndrome, haemostasis and thrombosis. Thrombosis and Haemostasis. 2008; 99: 995-1000.Alessi M.C., Juhan-Vague I. Metabolic syndrome, haemostasis and thrombosis. Thrombosis and Haemostasis. 2008; 99: 995-1000.Alessi M.C., Juhan-Vague I. Metabolic syndrome, haemostasis and thrombosis. Thrombosis and Haemostasis. 2008; 99: 995-1000.Andra H. James. Pregnancy-associated thrombosis. Hematology 2009; 277-285.Andra H. James. Pregnancy-associated thrombosis. Hematology 2009; 277-285.Anfossi G., Russo I., Trovati M. Platelet dysfunction in central obesity. Nutrition, Metabolism, and Cardiovascular Diseases. 2009; 19: 440-419.Anfossi G., Russo I., Trovati M. Platelet dysfunction in central obesity. Nutrition, Metabolism, and Cardiovascular Diseases. 2009; 19: 440-419.Bates S.M., Greer I.A., Pabinger I. et al. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008; 133: 844-886.Bates S.M., Greer I.A., Pabinger I. et al. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008; 133: 844-886.Bonetti P.O., Lerman L.O., Lerman A. Endothelial dysfunction: a marker of atherosclerotic risk. Arteriosclerosis, Thrombosis, and Vascular Biology. 2003; 23: 168-175.Bonetti P.O., Lerman L.O., Lerman A. Endothelial dysfunction: a marker of atherosclerotic risk. Arteriosclerosis, Thrombosis, and Vascular Biology. 2003; 23: 168-175.Branch D.W., Khamashta M.A. Antiphospholipid syndrome: obstetric diagnosis, management, and controversies. Obstet. Gynecol. 2003; 101: 1333-1344.Branch D.W., Khamashta M.A. Antiphospholipid syndrome: obstetric diagnosis, management, and controversies. Obstet. Gynecol. 2003; 101: 1333-1344.Cornier M.A., Dabelea D., Hernandez T.L., Lindstrom R.C., Steig A.J., Stob N.R., Van Pelt R.E., Wang H., Eckel R.H. The metabolic syndrome. Endocrine Reviews. 2008; 29: 777-822.Cornier M.A., Dabelea D., Hernandez T.L., Lindstrom R.C., Steig A.J., Stob N.R., Van Pelt R.E., Wang H., Eckel R.H. The metabolic syndrome. Endocrine Reviews. 2008; 29: 777-822.Despre´s J.P., Lemieux I., Bergeron J., Pibarot P., Mathieu P., Larose E., Rode´s-Cabau J., Bertrand O.F., Poirier P. Abdominal besity and the metabolic syndrome: contribution to global cardiometabolic risk. Arteriosclerosis, Thrombosis, and Vascular Biology. 2008; 28: 1039-1049.Despre´s J.P., Lemieux I., Bergeron J., Pibarot P., Mathieu P., Larose E., Rode´s-Cabau J., Bertrand O.F., Poirier P. Abdominal besity and the metabolic syndrome: contribution to global cardiometabolic risk. Arteriosclerosis, Thrombosis, and Vascular Biology. 2008; 28: 1039-1049.Diamant M., Nieuwland R., Pablo R.F., Sturk A., Smit J.W., Radder J.K. Elevated numbers of tissue-factor exposing microparticles correlate with components of the metabolic syndrome in uncomplicated type 2 diabetes mellitus. Circulation. 2002; 106: 2442-2447.Diamant M., Nieuwland R., Pablo R.F., Sturk A., Smit J.W., Radder J.K. Elevated numbers of tissue-factor exposing microparticles correlate with components of the metabolic syndrome in uncomplicated type 2 diabetes mellitus. Circulation. 2002; 106: 2442-2447.Fay W.P., Garg N. Sunkar M. Vascular functions of the plasminogen activation system. Arteriosclerosis, Thrombosis, and Vascular Biology. 2007; 27: 1231-1237.Fay W.P., Garg N. Sunkar M. Vascular functions of the plasminogen activation system. Arteriosclerosis, Thrombosis, and Vascular Biology. 2007; 27: 1231-1237.Franchini M., Targher G., Montagnana M. Lippi G. Themetabolic syndrome and the risk of arterial and venousthrombosis. Thrombosis Research. 2008; 122: 727-735.Franchini M., Targher G., Montagnana M. Lippi G. Themetabolic syndrome and the risk of arterial and venousthrombosis. Thrombosis Research. 2008; 122: 727-735.Horvath B., Bodecs T., Boncz I., Bodis J. Metabolic syndrome in normal and complicated pregnancies. Metab. Syndr. Relat. Disord. 2013 Jun; 11 (3): 185-8.Horvath B., Bodecs T., Boncz I., Bodis J. Metabolic syndrome in normal and complicated pregnancies. Metab. Syndr. Relat. Disord. 2013 Jun; 11 (3): 185-8.Jacobsen A.F., Skjeldestad F.E., Sandset P.M. Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium – a register-based casecontrol study. Am. J. Obstet. Gynecol. 2008; 198: 233 e231-237.Jacobsen A.F., Skjeldestad F.E., Sandset P.M. Incidence and risk patterns of venous thromboembolism in pregnancy and puerperium – a register-based casecontrol study. Am. J. Obstet. Gynecol. 2008; 198: 233 e231-237.James A.H. Venous thromboembolism in pregnancy. Arterioscler. Thromb. Vasc. Biol. 2009; 29: 326-331.James A.H. Venous thromboembolism in pregnancy. Arterioscler. Thromb. Vasc. Biol. 2009; 29: 326-331.Jara L.J., Medina G., Vera-Lastra O. Systemic antiphospholipid syndrome and atherosclerosis. Clin. Rev. Allergy Immunol. 2007 Apr; 32 (2): 172-7.Jara L.J., Medina G., Vera-Lastra O. Systemic antiphospholipid syndrome and atherosclerosis. Clin. Rev. Allergy Immunol. 2007 Apr; 32 (2): 172-7.Kim J.A., Montagnani M., Koh K.K., Quon M.J. Reciprocal relationships between insulin resistance and endothelial dysfunction: molecular and pathophysiological mechanisms. Circulation. 2006; 113: 1888- 1904.Kim J.A., Montagnani M., Koh K.K., Quon M.J. Reciprocal relationships between insulin resistance and endothelial dysfunction: molecular and pathophysiological mechanisms. Circulation. 2006; 113: 1888- 1904.Kobashi G., Ohta K., Yamada H., Hata A., Minakami H., Sakuragi N., Tamashiro H., Fujimoto S. Hokkaido. 4G/5G variant of plasminogen activator inhibitor-1 gene and severe pregnancy-induced hypertension: subgroup analyses of variants of angiotensinogen and endothelial nitric oxide synthase. J. Epidemiol. 2009; 19 (6): 275-80.Kobashi G., Ohta K., Yamada H., Hata A., Minakami H., Sakuragi N., Tamashiro H., Fujimoto S. Hokkaido. 4G/5G variant of plasminogen activator inhibitor-1 gene and severe pregnancy-induced hypertension: subgroup analyses of variants of angiotensinogen and endothelial nitric oxide synthase. J. Epidemiol. 2009; 19 (6): 275-80.Kotronen A., Yki-Järvinen H. Fatty liver: a novel component of the metabolic syndrome. Arteriosclerosis, Thrombosis, and Vascular Biology. 2008; 28: 27-38.Kotronen A., Yki-Järvinen H. Fatty liver: a novel component of the metabolic syndrome. Arteriosclerosis, Thrombosis, and Vascular Biology. 2008; 28: 27-38.Leila M., Ariane R., Maria S., Claudia B. Metabolic syndrome components in arterial hypertension. Rev. Esc. Enferm. USP. 2012; 46 (6): 1349-54.Leila M., Ariane R., Maria S., Claudia B. Metabolic syndrome components in arterial hypertension. Rev. Esc. Enferm. USP. 2012; 46 (6): 1349-54.Li H., Forstermann U. Nitric oxide in the pathogenesis of vascular disease. Journal of Pathology. 2000; 190: 244-254.Li H., Forstermann U. Nitric oxide in the pathogenesis of vascular disease. Journal of Pathology. 2000; 190: 244-254.Mina A., Favaloro E.J., Koutts J. Hemostatic dysfunction associated with endocrine disorders as a major risk factor and cause of human morbidity and mortality: a comprehensive meta-review. Seminars in Thrombosis and Hemostasis. 2007; 33: 798-809.Mina A., Favaloro E.J., Koutts J. Hemostatic dysfunction associated with endocrine disorders as a major risk factor and cause of human morbidity and mortality: a comprehensive meta-review. Seminars in Thrombosis and Hemostasis. 2007; 33: 798-809.Neville C., Rauch J., Kassis J., Chang E.R., Joseph L., Le Comte M., Fortin P.R. Thromboembolic risk in patients with high titre anticardiolipin and multiple antiphospholipid antibodies. Thromb. Haemost. 2003 Jul; 90 (1): 108-15.Neville C., Rauch J., Kassis J., Chang E.R., Joseph L., Le Comte M., Fortin P.R. Thromboembolic risk in patients with high titre anticardiolipin and multiple antiphospholipid antibodies. Thromb. Haemost. 2003 Jul; 90 (1): 108-15.Nieuwdorp M., Stroes E.S., Meijers J.C., Bu¨ller H. Hypercoagulability in the metabolic syndrome. Current Opinion in harmacology. 2005; 5: 155-159.Nieuwdorp M., Stroes E.S., Meijers J.C., Bu¨ller H. Hypercoagulability in the metabolic syndrome. Current Opinion in harmacology. 2005; 5: 155-159.Olufadi R., Byrne C.D. Effects of VLDL and remnant particles on platelets. Pathophysiology of Haemostasis and Thrombosis. 2006; 35: 281-291.Olufadi R., Byrne C.D. Effects of VLDL and remnant particles on platelets. Pathophysiology of Haemostasis and Thrombosis. 2006; 35: 281-291.Randriamboavonjy V., Fleming I. Insulin, insulin resistance, and platelet signaling in diabetes. Diabetes Care. 2009; 32: 528-530.Randriamboavonjy V., Fleming I. Insulin, insulin resistance, and platelet signaling in diabetes. Diabetes Care. 2009; 32: 528-530.Robertson L. Wu O., Langhorne P. et al. Thrombophilia in pregnancy: a systematic review. Br. J. Haematol. 2006; 132: 171-196.Robertson L. Wu O., Langhorne P. et al. Thrombophilia in pregnancy: a systematic review. Br. J. Haematol. 2006; 132: 171-196.Shamshirsaz A.A., Paidas M., Krikun G. Preeclampsia, hypoxia, thrombosis, and inflammation. J. Pregnancy. 2012; 2012: 374047.Shamshirsaz A.A., Paidas M., Krikun G. Preeclampsia, hypoxia, thrombosis, and inflammation. J. Pregnancy. 2012; 2012: 374047.Shoelson S.E., Lee J., Goldfine A.B. Inflammation and insulin resistance. Journal of Clinical Investigation. 2006; 116: 1793-1801.Shoelson S.E., Lee J., Goldfine A.B. Inflammation and insulin resistance. Journal of Clinical Investigation. 2006; 116: 1793-1801.Targher G., Chonchol M., Miele L., Zoppini G., Pichiri I. Muggeo M. Nonalcoholic fatty liver disease as a contributor to hypercoagulation and thrombophilia in the metabolic syndrome. Seminars in Thrombosis and Hemostasis. 2009; 35: 277-287.Targher G., Chonchol M., Miele L., Zoppini G., Pichiri I. Muggeo M. Nonalcoholic fatty liver disease as a contributor to hypercoagulation and thrombophilia in the metabolic syndrome. Seminars in Thrombosis and Hemostasis. 2009; 35: 277-287.Targher G., Bertolini L., Rodella S., Lippi G., Franchini M., Zoppini G., Muggeo M., Day C.P. NASH predicts plasma inflammatory biomarkers independently of visceral fat in men. Obesity. 2008; 16: 1394-1399.Targher G., Bertolini L., Rodella S., Lippi G., Franchini M., Zoppini G., Muggeo M., Day C.P. NASH predicts plasma inflammatory biomarkers independently of visceral fat in men. Obesity. 2008; 16: 1394-1399.Targher G. Non-alcoholic fatty liver disease, cardiovasthe metabolic syndrome and the risk of cardiovascular disease: the plot thickens. Diabetic Medicine. 2007; 24: 1-6.Targher G. Non-alcoholic fatty liver disease, cardiovasthe metabolic syndrome and the risk of cardiovascular disease: the plot thickens. Diabetic Medicine. 2007; 24: 1-6.Van Gaal L.F., Mertens I.L., De Block C.E. Mechanisms linking obesity with cardiovascular disease. Nature. 2006; 444: 875-880.Van Gaal L.F., Mertens I.L., De Block C.E. Mechanisms linking obesity with cardiovascular disease. Nature. 2006; 444: 875-880.Viall CA, Chen Q, Liu B, Hickey A, Snowise S, Salmon JE, Stone PR, Chamley L.W. Antiphospholipid antibodies internalised by human syncytiotrophoblast cause aberrant cell death and the release of necrotic trophoblast debris. J. Autoimmun. 2013 Sep 12; pii: S0896-8411(13)00111-X. doi: 10.1016/j. jaut.2013.08.005. [Epub ahead of print].Viall CA, Chen Q, Liu B, Hickey A, Snowise S, Salmon JE, Stone PR, Chamley L.W. Antiphospholipid antibodies internalised by human syncytiotrophoblast cause aberrant cell death and the release of necrotic trophoblast debris. J. Autoimmun. 2013 Sep 12; pii: S0896-8411(13)00111-X. doi: 10.1016/j. jaut.2013.08.005. [Epub ahead of print].Weisberg S.P., McCann D., Desai M., Rosenbaum M., Leibel R.L., Ferrante A.W. Obesity is associated with macrophage ccumulation in adipose tissue. Journal of Clinical Investigation. 2003; 112: 1796-1808.Weisberg S.P., McCann D., Desai M., Rosenbaum M., Leibel R.L., Ferrante A.W. Obesity is associated with macrophage ccumulation in adipose tissue. Journal of Clinical Investigation. 2003; 112: 1796-1808.Xie H., Sheng L., Zhou H., Yan J. The role of TLR4 in pathophysiology of antiphospholipid syndrome-associated thrombosis and pregnancy morbidity. Br J. Haematol. 2013 Oct 8; doi: 10.1111/bjh.12587. [Epub ahead of print].Xie H., Sheng L., Zhou H., Yan J. The role of TLR4 in pathophysiology of antiphospholipid syndrome-associated thrombosis and pregnancy morbidity. Br J. Haematol. 2013 Oct 8; doi: 10.1111/bjh.12587. [Epub ahead of print].Zhang D., Jiang X., Fang P., Yan Y., Song J., Gupta S., Schafer A.I., Durante W., Kruger W.D., Yang X., Wang H. Hyperhomocysteinemia promotes inflammatory monocyte generation and accelerates atherosclerosis in transgenic cystathionine beta-synthase-deficient mice. Circulation. 2009 Nov 10; 120 (19): 1893-902.Zhang D., Jiang X., Fang P., Yan Y., Song J., Gupta S., Schafer A.I., Durante W., Kruger W.D., Yang X., Wang H. Hyperhomocysteinemia promotes inflammatory monocyte generation and accelerates atherosclerosis in transgenic cystathionine beta-synthase-deficient mice. Circulation. 2009 Nov 10; 120 (19): 1893-902.

The authors declare that there are no conflicts of interest present.