正常孕妇和妊娠晚期糖尿病患者止血功能指标的研究

The Investigation of Hemostatic Function Between late Normal Pregnant Women and Late Gestational Diabetes

目的检测正常妊娠妇女在妊娠不同时期血管、血小板、凝血及纤溶系统部分指标的变化,应用血小板微颗粒(PMP)指标及血栓弹力图(TEG)评价妊娠晚期正常孕妇与妊娠期糖尿病(GDM)患者晚期凝血功能的改变,并与传统凝血指标比较,探讨其在产科出血风险和孕期血栓前状态评估的临床意义。方法采用流式细胞仪对正常妊娠妇女687例(早孕妇女105例,中孕妇女319例,晚孕妇女263例)、妊娠晚期糖尿病妇女29例,进行PMP检测。采用ELISA法分别对正常妊娠妇女123例(早孕妇女30例,中孕妇女49例,晚孕妇女44例)进行凝血酶调节蛋白(TM)、纤维蛋白原(Fbg)、组织纤溶酶原激活物(tPA)、组织纤溶酶原激活物的抑制物(PAI)、血小板颗粒膜糖蛋白140(GMP140)、蛋白C(P C)、凝血酶原片段(F1+2)检测。采用Stago全自动血凝仪及血栓弹力图分析仪分别对正常妊娠晚期妇女83例、妊娠晚期糖尿病妇女73例,进行了凝血过筛试验、D二聚体(D-D)和TEG等项目检测。结果正常妊娠妇女不同孕期PMP、TM、Fbg、tPA、PAI、GMP140、P C、F1+2比较差异无统计学意义(P>0.05);晚期妊娠糖尿病组凝血过筛试验和D-D与晚期正常孕妇组比较差异无统计学意义(P>0.05);妊娠晚期糖尿病组PMP、TEG各项指标明显异常,与正常组比较差异有统计学意义(P<0.05)。结论 PMP及TEG可以敏感检出妊娠晚期糖尿病患者止血功能的异常,对评估妊娠期糖尿病病程的发展、产妇出血风险和孕妇血栓前状态有重要的临床意义。

Objective To evaluate the clinical significance of the following indicators in obstetric hemorrhage risk and pregnancy prothrombotic state assessment by detecting the indicators changes of the blood vessels, platelets, coagulation and fibrinolysis of normal pregnant women in pregnancy period, and by detecting the traditional coagulation indicators, PMPs and TEG changes of the late pregnancy of normal pregnant women with gestational diabetes mellitus （GDM）. Methods Enrolled 687 cases of normal pregnant women including 105 cases of women in early pregnancy,319 cases of mid-pregnant women and 263 cases of women in late pregnancy ,29 cases of GDM for PMP testing by flow cytometer. Enrolled 123 cases of normal pregnant women including 30 cases of women in early pregnancy,49 cases of mid-pregnant women and 44 cases of women in late pregnancy for testing the thrombomodulin, fibrinogen, tissue plasminogen activator, plasminogen activator inhibitor, α-granule membrane protein, protein C and prothrombin fragment 1 ＋ 2 by ELISA. Enrolled 83 cases of normal pregnant women and 73 cases of GDM for testing the traditional coagulation indicatorsand by Automatic coagulation analyzer and TEG by thrombelastography. Results The PMP, TM, Fbg, tPA, PAI, GMP140, PC, F 1 ＋ 2 differences of normal pregnant women in different gestational ages were not statistically significant （P 〉 0.05 ） ,the difference of coagulation test and D-D between late gestational diabetes group and late normal pregnant women group was not statistically significant （ P 〉 0.05 ） , the PMP and TEG indicators between late gestational diabetes group and late normal pregnant women group was statistically significant （P 〈 0.05 ）.Conclusion PMP and TEG indicators can sensitively detect the hemostatic function abnormalities in late pregnancy diabetes and they are of great clinical importance for evaluating the development of GDM, the risk of maternal hemorrhage and maternal prothrombotic state.