妊娠期妇女活化蛋白C抵抗及其发生机制的研究

ACTIVATED PROTEIN C RESISTANCE AND ITS MECHANISM IN PREGNANT WOMEN

目的探讨妊娠期妇女血浆中活化蛋白C抵抗(APCR)现象发生的原因以及与凝血因子V基因多态性、狼疮抗凝物质(LA)等的关系。方法应用多聚酶链反应-限制性内切酶长度多态性分析(PCR-RFLP)法对FV基因进行分析,同时用APTT-APC法、简化的单管稀释蝰蛇毒时间测定法(DVVT)以及酶联免疫吸附双抗体夹心法(ELISA)检测APCR敏感性比值、LA水平以及抗磷脂抗体Ig G(ACA Ig G)含量。结果NC正常化APCR敏感指数比值(n-APCR-SR)为(0.95±0.16),NP有22例n-APCR-SR<0.63,即APCR阳性率为44%,NC组仅为2例阳性(4%);在妊高征组(PIH)有12例,占总数的40%;习惯性流产组(HA)4例,占总数的20%。各组间在APCR方面存在显著性差异(P<0.01或P<0.05)。APCR阳性者均为检测到F V Leiden突变;同时发现LA阳性率和APCR阳性率在NP组有很好的一致性。结论APCR可能是妊娠期高凝状态一个危险因素,但并非是FV基因点突变引起的;LA和ACAIgG可能是获得性APCR的一个重要原因。

Objective To explore the activated protein C resistance （APCR） and its relation to FV leiden mutation and lumpous antibody（LA）. Methods PCR-RELP was used to conduct geneanalysis. APTT-APC, simplified DVVT and ELISA were used to determine the APCR sensitivity and the levels of LA and ACA IgG. Results The n-APCR-SR was（0.95 ± 0.16） in NC group. 22 cases had their n-APCR-SR less than 0.63 ,with the APCR positive rate being 44% in NP group. The positive rates in groups of NC,PIH,HA were 4% （2 cases） ,40% （12 eases） and 20 % （4 cases ） respectively（ P 〈 0.01, orP 〈 0.05）. APCR-positive patients were found to have FV Leide mutations. Concordance of LA and APCR in terms of positive rate in NP group was found. Conclusion APCR may be a risk factor in pregnancy but is not caused by FV Leide mutation. LA and ACA IgG may be one of the major factors leading to APCR.