妊娠中晚期糖尿病患者血栓前状态的研究

The Investigation of Prethrombotic State of Normal Late Pregnancy Women

目的检测妊娠中、晚期糖尿病(GDM)患者凝血及纤溶系统部分指标的变化,探讨其血管内皮损伤情况及其在血栓前状态(PTS)中的临床意义。方法采用ELISA法和CA1500型全自动血凝仪分别对正常妊娠妇女、妊娠中晚期糖尿病妇女各30例,以及正常妇女20例血浆标本进行血管性血友病因子抗原(vWF:Ag)、纤维蛋白原(Fbg)、D-二聚体(D-D)等指标的测定。结果妊娠中、晚期糖尿病组Fbg、vWF、D-D明显高于正常组(P<0.05);中期妊娠糖尿病组Fbg、vWF、D-D(2.87±0.35 mg/L、183.8%±19.5%、0.55±0.31 mg/L)明显高于中期正常孕妇组(0.61±0.29mg/L、252.7%±15.2%、3.37±0.753 mg/L,P<0.05),差异均具有统计学意义;晚期妊娠糖尿病组Fbg、vWF:AG、D-D与晚期正常孕妇组比较差异无统计学意义(P>0.05)。结论妊娠中晚期糖尿病患者存在明显血栓前状态。测定妊娠中晚期糖尿病患者有关凝血和纤溶功能指标,对妊娠期糖尿病的发展、血栓前状态的判断以及保证孕妇和胎儿的安全有重要的临床意义。

Objective To examine the indicators of the coagulation and fibrinolytic system in patients with gestational diabetes mellitus （GDM）. And to discuss the clinical significance of these indicators that in judging the lesion- condition of blood vessel endothelium and prethrombotic state （PTS）. Methods ： D- dimmer （ D- D）, yon Willebrand factor antigen （ vWF ： Ag）, fibrinogen （Fbg） were measured by ELISA in 30 GDM women, normal late pregnancy women, and 20 non-pregancy women. Results In GDM group Fbg, D-D, vWF：Ag （ 2.87 ±0.35 mg/L,183.8% ± 19.5% ,0.55±0.31 mg/L） were significantly higher than the corresponding normal values （ P 〈 0. 05 ）. In GDM group and normal late pregnancy group the plasma levels of Fbg, D-D, vWT：Ag（0. 61±0.29 rag/L,252.7%± 15.2% ,3.37 ±0. 753 mg/L,P 〈0.05）, where obviously higher than those of non-pregnancy group . Conclusion Normal late GDM patients developed obvious PTS. Measuring these indicators of coagulation and the function of fibrinolytic system for normal late GDM pa- tients is of great clinical importance for determining the development of GDM, PTS as well as ensuring the health and safety of mother and the fetus.