Plasminogen activators and inhibitors, D-dimer and β-TG in systemic lupus erythematosus pregnancy in relation to their obstetric outcome

Summary

We studied 52 systemic lupus erythematosus (SLE) pregnant patients (28 full term pregnancy, 15 pre-term delivery, eight abortions, and one intrauterine death for fibrinolytic and inhibitors status as compared with nortnal pregnancy. All patients were on prednisolone treatment before and during pregnancy. The elevated tissue plasminogen activator (t-PA) antigen and urokinase-like (u-PA) antigen levels in gestation matched SLE patients who aborted suggesting an enhanced endothelial release or tissue damage. The higher I)-dimer levels seen also indicate enhanced fibrinolysis resulting from endothelial release of plasminogen activators. In the SLE patient with an intra uterine death. a significantly elevated PAI-I activity (140 AUlml) and antigen (132 ng/ml) were seen. Like normal pregnancy, SLE pregnancy showed rising trends for antigen levels of t-PA, PAI-1, PAI-2. plasminogen and D-dinier. β-TG level was similar to normal pregnancy. However, unlike normal pregnancy significant reduction in antigen levels of u-PA, PAIL1 and PAI-2, and with elevated level of t-PA antigen were evident in SLE pregnancy. PAI-2 levels were significantly reduced from mid-trimester in the pre-term group whilst significant reduction was seen only in the third trimester of the full term group. These findings in SLE pregnancy with viable pregnancy outcome together with elevated t-PA antigen are similar to our earlier report on preeclampsia and suggest poor placental function. associated with microthrombosis and placental infarcts frequently seen in SLE-pregnancy.