Clinical and Immunomorphological Features of Liver Damage in Severe Preeclampsia

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Abstract


Background. Liver diseases associated with pregnancy are recorded in 0.7–3% of pregnant women, often accompanied by the development of hepatic dysfunction/insufficiency, and are the cause of increased morbidity and mortality in both mother and child. A pathomorphological study helps to understand the pathophysiology of severe liver damage in preeclampsia, and to optimize the management of such patients. Aims — to study the clinical, morphological and immunohistochemical features of liver tissue lesions in the most severe forms of preeclampsia and eclampsia, which ended in death. Methods. Autopsy material analysis of 10 patients who died from preeclampsia, eclampsia and their complications (main group) and 3 patients who died from other causes (comparison group). Pathomorphological and immunohistochemical studies of organs and tissues (in particular, liver tissue) were performed using a marker of neurons and neuroendocrine cells γ-NSE and a marker of endotheliocytes CD-34. Results. An immunohistochemical study with a CD-34 endotheliocyte marker in the main group revealed a vascularization deficiency in the 2nd and 3rd zone of hepatic acini, there were also foci of necrosis. Such changes indicate deep and prolonged hypoperfusion. The use of the NSE marker in the group of patients who died from preeclampsia/eclampsia revealed a sharp increase in Kupffer cells in the first and second zones of acini with pronounced immunoexpression of NSE in the nuclei and cytoplasm of these cells, which indicates severe hepatic dysfunction (in particular, impaired detoxification and elimination functions of the liver). At the same time, only 3 out of 10 women in the main group are clinically registered with HELLP syndrome, while the rest had signs of multiple organ (including acute liver) failure. Conclusions. The clinical symptoms of liver damage, including those with severe preeclampsia, arise, as a rule, already against the background of severe morphological changes in its tissue and, as a rule, indicate functional decompensation. Liver immunology remains little studied, which requires further research on this problem.


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About the authors

Iraida S. Sidorova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: sidorovais@yandex.ru
ORCID iD: 0000-0003-2209-8662
SPIN-code: 3823-8259

Russian Federation, Moscow

MD, PhD, Professor, Academician of the RAS

Natalya A. Nikitina

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: natnikitina@list.ru
ORCID iD: 0000-0001-8659-9963
SPIN-code: 8344-1517

Russian Federation, Moscow

MD, PhD, Professor

Mikhail B. Ageev

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: mikhaageev@yandex.ru
ORCID iD: 0000-0002-6603-804X
SPIN-code: 3122-7420

Russian Federation, Moscow

MD, PhD

Albert A. Kokin

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: alberkokin@yandex.ru
ORCID iD: 0000-0001-7615-4530

Russian Federation, Moscow

MD, Resuscitator

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Supplementary files

Supplementary Files Action
1.
Figure: 1. Comparison group: A - the presence of hypertrophied binuclear hepatocytes (arrows) in the periportal region (acinus zone 1) (pathological examination, staining with hematoxylin and eosin, × 100); B - branched capillary network (arrows) in zone 1 and partly in zone 2 of acini (immunohistochemical study with the marker CD-34, × 50)

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2.
Figure: 2. Eclampsia - the main group: total necrosis of hepatocytes and focal hemorrhages (arrows) in three zones of the hepatic acinus (pathological examination, staining with hematoxylin and eosin, × 50)

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3.
Figure: 3. Preeclampsia - main group: A - rarefaction of the capillary network (arrows) in zones 1 and 2 of the hepatic acinus (immunohistochemical study, marker CD-34, × 100); B - pronounced immunoexpression of NSE in the nuclei and cytoplasm of hepatic macrophages (Kupffer's cells) against the background of hypertrophied hepatocyte nuclei (immunohistochemical study, NSE marker, × 400)

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