早期妊娠妇女凝血4项与血栓前状态分子标志的临床意义

Coagulation and prothrombotic state parameters： clinical analysis in early pregnancy

目的分析正常早期妊娠凝血4项与血栓前状态分子标志物，了解妊娠后凝血、血栓形成、抗凝和纤溶状态的改变。方法选取2005年4月至2009年6月于中山大学孙逸仙纪念医院定期产检的105例妊娠10—12周的孕妇为研究组，另选取82例正常未孕者为对照组。测定凝血常规4项（凝血酶时间、活化部分凝血活酶时间、血浆凝血酶原时间及纤维蛋白原）及血栓前状态分子标志物[凝血酶原片段（F1＋2）、血栓调节蛋白（TM）、凝血酶一抗凝血酶复合物（TAT）、抗凝血酶Ⅲ（AT-Ⅲ）、血小板颗粒糖蛋白140（GMPl40）、血栓烷B2（TXB2）、D二聚体（D-Ⅱ）、纤溶酶原激活物抑制物（PAI-2）]。结果F只、F1＋2、TAT、GMPl40、D-Ⅱ、PAI-2两组比较差异有统计学意义（P〈0．01），前者分别为4．00g／L、0．66nmol／L、179．95μg/L、9．42μg/L、201．51μg/L、0．047μg/L．后者分别为2．52μg/L、0．31nmol／L、39．46μg/L、19．13μg/L、125．02μg/L、0．006g／L。结论正常妊娠早期血液凝血功能明显增高，抗凝水平略升高、纤溶活性及抗纤溶活性亦出现明显亢进，4者在较高水平保持平衡，血小板活化状况保持在低水平。

Objective To assess the changes in coagulation, thrombosis, anti-coagulation and fibrinolysis during early preguaney. Methods A total of 105 gravidas with monocyetic pregnancies between 10 and 12 weeks gestational age at Sun Yat-sen Memorial Hospital, Sun Yat-sen University during April 2005 to June 2009 were recruited for study group and another 82 non-pregnant women as control group. Coagulation parameters, including thrombin time （T＇F）, activated partial thromboplastin time （APTT）, prothrombin （PT） and fibrinogen （ Fg）, were measured. We also tested the prothrombotie state parameters, including prothrombin fragment 1 ＋ 2 （ F1 ＋ 2 ） , thrombomodulin （TM） , thrombin-antithrombin complex （TAT）, antithrombin ]II（ AT-m ） , GMP140, thromboxane B2 （ TXB2 ）, plasminogen activator inhibitor （ PAI-2 ; performed by enzyme-linked immunosorbent assay） and D-direct （ D2 ; tested by latex turbidimetrie immunoassay）. Results Fg （4.00 vs2.52 g/L）, F1 ＋2 （0.66 vs 0.31 nmol/L）, TAT （179.95 vs 39.46 μg/L）, GMP140 （9.42 vs 19. 13μg/L）, D2 （201.51 vs 125.02 μg/L） and PAI-2 （0.047 vs 0.006 g/L） were statistically different between the study and control groups （ P 〈0.01 ）. Conclusions The coagulation, fibrinolysis and anti-fibrinolysis functions of healthy pregnant women become enhanced during early pregnancy while anti-coagulation function slightly increases. These four basic functions are balanced at a higher level so that the activation of platelets stays at a lower level.