正常妊娠妇女和妊娠期高血压疾病患者血浆TAFI和PAI-2变化的研究

Changes of plasma TAFI and PAI-2 antigen levels in normal pregnant women and patients with hypertensive disorders complicating pregnancy

目的:探讨凝血酶活化的纤维蛋白溶解抑制物(TAFI)和纤维酶原激活抑制物-2(PAI-2)在正常妊娠妇女和妊娠高血压疾病患者血浆中的变化及其临床意义。方法:研究对象包括22例妊娠期高血压疾病患者(其中子痫前期10例、妊娠期高血压12例)、30例正常妊娠妇女和30例正常未孕妇女,应用酶联免疫吸附试验(ELISA)测定研究对象妊娠早、中、晚三期血浆中的TAFI和PAI-2抗原水平。结果:与未孕对照组比较,正常妊娠组妊娠各期PAI-2均明显升高,差异均有显著统计学意义(P均<0.01),而TAFI在孕晚期才明显高于未孕组,差异有统计学意义(P<0.05),与正常妊娠组比较,妊娠期高血压组妊娠三期中TAFI、PAI-2抗原水平差异无统计学意义(P>0.05),子痫前期组妊娠三期TAFI明显高于正常妊娠组,而PAI-2均低于正常妊娠组,差异均具有统计学意义(P<0.05)。结论:TAFI、PAI-2在正常妊娠妇女发挥着纤溶抑制作用,维持母体凝血和纤溶的平衡。TAFI是一个预测子痫前期的敏感指标,有助于预测子痫前期患者血栓前状态的形成,而PAI-2不能用来判断母体内纤溶水平变化,但可能预示不良妊娠结局。两者对于妊娠期高血压患者的临床意义不大。

Objective： To investigate the changes and clinical significances of TAFI and PAI -2 antigen levels in normal pregnant women and patients with hypertensive disorders complicating pregnancy. Methods： Using enzyme - linked immunosorbent assays, TAFI and PAI -2 were simultaneously measured in 22 patients with hypertensive disorders complicating pregnancy （ preeclampsia, n = 10; gestational hypertension, n = 12）, 30 normal pregnant women and 30 normal impregnate women in the 1st , 2nd, and 3rd trimester. Results： Compared with normal unpregnancy group, significantly elevated PAI -2 and TAFI antigen levels in normal pregnancy group were found in the 1st, 2nd, and 3rd trimester, respectively （P 〈0. 05） . Increased TAFI and decreased PAI -2 were found in patients with PE compared to normal pregnancy at each trimester （P 〈 0. 05）, but there were not significant differences between gestational hypertension group and normal pregnancy group. Conclusion： Elevated TAFI and PAI - 2 contribute to the inhibition of fibrinolysis in order to maintain the balance of coagulation and fibrinolysis in normal pregnant women. In patients with PE, excessively increased TAFI antigen levels enhanced the prethrombotic state and can help in predicting the impairment of fibrinolysis in preeclampsia at early stage. Decreased PAI - 2 cant suggest the inhibition of fibrinolysis and may be related with bad gestational results. The two parameters have no use of detecting the gestational hypertension.