产科早期弥漫性血管内凝血患者止凝血功能的研究

Study of thrombotic molecular markers in normal pregnant women and patients with disseminated intravascular coagulation

目的研究正常孕妇不同孕期和产科早期弥漫性血管内凝血(DIC)患者的凝血、抗凝、纤溶和血管内皮系统的功能,了解所用分子标志物在早期诊断产科DIC中的价值和意义。方法检测了31例早孕、14例中孕、62例晚孕、34例产科早期DIC和31名正常对照的常规止凝血功能指标凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(Fbg)、血小板(PLT)和分子标志物凝血酶原片段(F1+2)、凝血酶-抗凝血酶Ⅲ复合物(TAT)、纤维蛋白单体(FM)、血栓调节蛋白(TM)和D-二聚体(D-dimer)。结果PT、APTT在各实验组间差异无统计学意义(P>0·05),早期DIC组PLT(155±60)×109/L低于对照组(241±63)×109/L和妊娠各期组[分别为早孕组(233±64)×109/L、中孕组(203±50)×109/L、晚孕组(216±55)×109/L](P<0·05),Fbg、F1+2、TAT、FM、TM、D-dimer随着妊娠时间的延长浓度逐渐升高(P<0·05),早期DIC组Fbg(4·0±1·0)g/L与中孕组(3·8±0·8)g/L、晚孕组(4·1±0·5)g/L相比差异无统计学意义(P>0·05),早期DIC组TAT7·40(14·01)μg/L与中孕组6·41(5·51)μg/L、晚孕组8·58(5·84)μg/L相比差异无统计学意义(P>0·05)。早期DIC组F1+2(4·43±1·43)nmol/L、TM(31·5±8·5)μg/L、FM(43·7±16·8)mg/L、D-dimer(630±479)μg/L浓度显著升高,明显高于对照组和妊娠各期组(P<0·05)。除PLT和Fbg之间不存在直线相关关系外,指标F1+2、TAT、FM、TM、D-dimer、PLT、Fbg间均存在直线相关关系或等级相关关系(P<0·05)。结论TAT、Fbg可反映机体高凝状态,但不能早期诊断产科DIC。F1+2、FM、TM、D-dimer可作为早期诊断产科DIC的敏感指标。

Objective To study the function of coagulation, anti-coagulation and fibrinolysis in normal pregnant women and patients with disseminated intravascular coagulation （ DIC）, and to study the clinical value of prothrombotic molecular markers to diagnose DIC early. Methods Routine coagulation tests prothrombin time （ PT）, activated partial thrombopastin time （ APTT）, fibrinogen （ Fbg）, platelet （PLT） and the levels of molecular markers included prothrombin fragment 1 ＋ 2 （ F1 ＋ 2）, thrombin anti-thrombin III complex （TAT）, fibrin monomer （FM）, thrombomodulin （TM）, D-dimer were determined in plasma of 34 early DIC pregnant patients, 31 early-pregnant women, 14 middle-pregnant women, 62 later-pregnant women and 31 normal controls. Results No significant difference were found in the amounts of PT and APTT in all tested groups （P 〉0. 05）. The amounts of PLT in patients with DIC（ 155 ±60） × 10^9/L was significantly lower than that in normal controls （ 241 ＋ 63 ） × 10^9/L and normal pregnant women [ earlypregnant women （233 ±64） × 10^9/L,middle- pregnant women （203 ±50） × 10^9/L,later-pregnant women （216＋55） × 10^9/L,respectively] （P 〈0.05）. The amounts of Fbg, F1 ＋2, TAT, FM, TM, D-dimer increased with increasing of pregnant month （ P 〈 0. 05 ） . No significant difference was found in the amounts of TAT and Fbg in the patients with DIC and normal pregnant women except early-pregnant women （ P 〉 0. 05 ）. The amounts of F1 ＋ 2 （4.43 ± 1.43 ） nmol/L, TM （ 31.5 ± 8.5 ） μg/L, FM （ 43.7± 16. 8 ）μg/L, D-dimer （630 ± 479 ）μg/L were significantly higher than that in normal controls and normal pregnant women （ P 〈 0. 05）. Significant correlation were found among F1 ＋ 2, TAT, FM, TM, D-dimer, PLT, Fbg （P 〈0. 05）. However, no significant correlation was found between PLT and Fbg （P 〉0. 05）. Conclusion Fbg and TAT can indicate the activated coagulation state, however, they can not be used as sensitive parameters for early diagnosis of DIC. F1 ＋ 2, FM, TM, D-dimer are valuable for early diagnosis of DIC.