凝血及纤溶相关因子改变与重度子痫前期发病的关系研究

Study on Correlation between Changes in Coagulation and Fibrinolysis Related Factors and Incidence of Severe Pre-eclampsia

目的探讨凝血前状态患者P-选择素(GMP-140)、D-二聚体(D-D)等因子改变与重度子痫前期发生的关系。方法选择孕20～36w的孕妇200例,按初选孕周分为4组,定期检测其外周血血小板(PLT)、P-选择素(GMP-140)、D-二聚体(D-D)、纤维蛋白原(FIB)含量及凝血酶原时间(PT)和部分凝血活酶时间(APTT)。连续两次测定两项及以上指标异常者为高危孕妇,并随机分为两亚组,治疗组采用肝素及丹参静滴,对照组以生理盐水静滴,动态观察血凝系统指标,分析其发病情况。结果重度子痫前期患者PLT、PT、APTT值明显降低(P<0.05),其血浆中GMP-140及D-D浓度明显高于对照组(P<0.05)。以GMP-140≥68.0lg/L和D-D≥0.28mg/L为预测值,在1组阳性预测值、阴性预测值、特异性和灵敏性4项指标分别为55.5%、78.1%、51.3%、81.2%,2组分别是82.1%、79.3%、68.2%、84.4%,3组分别是85.3%、83.1%、76.4%、85.3%,4组分别是87.2%、89.1%、80.8%、90.6%。治疗组重度子痫前期发生率为7.50%,对照组为17.76%,两组比较差异有统计学意义(P<0.05)。结论凝血前状态GMP-140和D-D异常改变与子痫前期发生密切相关,有望成为子痫前期的良好预测指标,肝素及丹参治疗有效。

Objective To investigate the correlation between severe pre - eclampsia and the changes of factors such as GMP - 140, D - dimer （ D - D） in pro - coagulation. Methods 200 pregnant women of 20 to 36 gestational weeks were collected and classified into 4 groups according to the gestational weeks. PT, APTT, and the level of PLT, GMP - 140, D - D, FIB in the peripheral blood were detected. The pregnant women who had two or more abnormal indexes were considered as high risk, and were divided into two groups randomly. The treatment group was dealt with intravenous drip of heparin and salvia, while the control group was given normal sodium instead. The indexes of blood coagulation system were measured dynamically and the disease incidence was collected. Results The levels of PLT, PT and APTT were significantly lower in heavy pre - eclampsia patients （ P 〈 0.05 ）, with the concentrations of GMP - 140 and D - D in plasma significantly higher （ P〈 0. 05 ）, compared to the control group. As for predicting, when the level of GMP - 140 greater than or equal to 68.0 lg/L and D - D greater than or equal to 0. 28mg,/L, the positive predictive value of the incidence of heavy pre - eclampsia was 55.5% while the negative predictive value reached 78. 1%. The specificity and sensitivity were 51.3% and 81.2% in the first group, respectively. In the second group, these indexes were 82. 1%, 79. 3%, 68. 2% and 84. 4% respectively. In the third group , they were 85. 3%, 83.1%, 76.4% and 85.3% respectively. In the forth group , they were 87.2%, 89. 1%, 80.8% and 90.6% respectively. The incidence rate of severe pre - eclampsia was 7.5% in the treatment group and 17.76% in the control group. There was a significant difference between the two groups （ P 〈0. 05 ）. Conclusion GMP - 140 and D - D are two reliable indicators for pre - eclampsia in patients of pre - coagulation. Moreover, the incidence of pre - eclampsia can be degraded if heparin and salvia are used early.