重度子痫前期患者血浆凝血、纤溶相关因子水平变化的意义

The changes of coagulant and fibrinolytic factors in plasma of patients with severe preeclampsia

目的:探讨凝血相关因子在重度子痫前期患者外周血病理性高凝状态发病机制中的作用。方法:采用ELISA方法测定30例重度子痫前期孕妇(子痫前期组)及42例正常晚期妊娠孕妇(正常妊娠组)外周血凝血相关因子的浓度,包括TF、TFPI、t-PA、PAI-1和PAI-2,并进行对比分析。结果:两组孕妇的年龄、孕周无显著性差异;重度子痫前期组患者的D-二聚体浓度及FDP阳性率均显著高于对照组而血小板计数则显著低于对照组。子痫前期组的血浆TF浓度为(53.02±8.64)pg/ml显著高于对照组的(30.84±9.04)pg/ml,TFPI浓度为(3.04±1.08)ng/ml则显著低于对照组的(5.13±0.93)ng/ml(P<0.01);子痫前期组的t-PA浓度为(42.03±16.08)ng/ml显著低于对照组的(67.12±18.91)ng/ml(P<0.01);子痫前期组PAI-1、PAI-2的浓度分别为(81.37±14.87)ng/ml、(469.14±29.20)ng/ml均显著高于对照组的(63.15±8.88)ng/ml和(122.56±17.67)ng/ml。结论:重度子痫前期患者的病理性高凝血状态和凝血相关因子的平衡失调有关,内皮细胞的损伤或激活、胎盘表达凝血相关因子异常可能是重要原因。

Objective： To explore the pathogenesis of thrombophilia in severe preeclampsia patients. Methods： 30 cases of severe preeclampsia patient＇s （study group） and 42 cases of normal late pregnant women＇s （control group） plasma levels of tissue factor （TF）, tissue factor pathway inhibitor （TFPI）, tissue - type plasminogen ativator （ t - PA）, plasminogen activator inhibitor - 1 （PAI - 1 ）, and plasminogen activator inhibitor - 2 （PAI - 2） were measured by ELLISA. Results： There were no significant difference in gestational age and pregnant women＇age between two groups. The plasma D - dimer levels in severe preeclampsia group were significant higher than control group, and so as the positive rates of FDP between two groups. The TF level （53. 02 ± 8. 64） pg/ml in study group was significant higher than the level （ 30. 84 ± 9. 04 ） pg/ml in control group （ P 〈 0. 01 ）. However TFPI level （ 3.04 ± 1.08 ） ng/ml in study group was significant lower than the level （5. 13 ± 0. 93 ） ng/ml in control group （ P 〈 0. 01 ） . The plasma levels of t - PA in study group and control group were （42. 03 ±16. 08） ng/ml and （67. 12 ± 18. 91 ） ng/ml respectively, there was significant difference between two groups. Both PAI- 1 plasma level （81.37 ± 14. 87） ng/ml and PAI-2 plasma level （469. 14 ±29. 20） ng/ml in severe preeelampsia patients were significant higher than PAI- 1 plasma level （63. 15 ± 8. 88） ng/ml and PAI- 2 level （122. 56 ± 17. 67） ng/ml in control group （P 〈0. 01 ） . Conclusion：The thrombophilia in severe preeclampsia patients is associated with imbalance of plasma coagulation factors, vascular endothelial cells activation or damage and abnormal expression of coagulation factors in placenta may be the main cause.