正常妊娠妇女血中活化的蛋白C抵抗、狼疮样抗凝物质与血栓前状态分子标志物测定

Measurement of activated protein C resistance, lupus-like anticoagulant and prethrombotic markers in normal gestation

目的研究活化的蛋白 Ｃ抵抗（Ａｃｔｉｖａｔｅｄ ｐｒｏｔｅｉｎ Ｃ ｒｅｓｉｓｔａｎｃｅ，ＡＰＧＲ）在正常妊娠中的发生情况，探讨狼疮抗凝物质（Ｌｕ－ｐｕｓ－ｌｉｋｅ ａｎｔｉｃｏａｇｕｌａｎｔ，ＬＡ）对妊娠性 ＡＰＣ－Ｒ的影响及二者与凝血酶生成、继发性纤溶的关系。方法采用 ＡＰＴＴ－ＡＰＣ法检测ＡＰＣ－Ｒ、ｄＲＶＶＴ法测定ＬＡ水平，并用 ＥＬＩＳＡ法测定了凝血酶原片段Ｆ１＋２和Ｄ－二聚体（Ｄ－ｄｉｍｅｒ，Ｄ－Ｄ）的含量。结果检测３０例正常妇女对照（ＮＣ）和５０例正常妊娠妇女，ＮＣ组ＡＰＣ－Ｒ比率为２．８８±０．３７，ＮＰ组为２．０４±０．３１（ＡＰＣ－Ｒ阳性率为４２％）；ＮＣ组 ＬＡ阳性率为 ０， ＮＰ组为 ３６．７％； ＮＣ组 Ｆ１＋２为（０．７３４ ± ０．４２） ｎｍｏｌ／Ｌ， ＮＰ组为（ １．０５ ± ０．６９） ｎｍｏｌ／Ｌ； ＮＣ组Ｄ－Ｄ为（０．４８±０．０５）ｍｇ／Ｌ，ＮＰ组为（０．６３±０．１１）ｍｇ/Ｌ；ＮＰ组的ＡＰＣ比率、Ｆ１＋２和Ｄ－Ｄ的测定结果均较ＮＣ组有显著性差异。结论妊娠可能发生与ＬＡ升高有关的ＡＰＣ－Ｒ，并导致了凝血酶激活物生成增加以及凝血酶、纤溶酶的激活和继发性纤溶的发生。

Objective To investigate the activated protein Cresistance (APC- R ) occurred in normal pregnancy women and the effect of lupus-like anticoagulant(LA) on it, as well as to discuss the relationships between them and coagulation / fibrinolysis activation. Methods APC sensitivity ratio,was assessed using APTT-APC method, LA was measured using dRVVT medthod, prothrombin frag- ment F1+2and D-dimer were assayed using ELISA Kits.Results 30 normal women controls(NC group)and 50 normalprgnancy women at 28-32 week's gestation(NP group)were measured.We found lower APC sensitivity ratio in normal group(2 .04± 0.31) than that in normal group (2.88 ± 0.37) .None LA positive was found in normal group but there were 36% LA positive samples in normal group.The F1 +2 and D-dimer levels in normal group were (0 .73 ± 0. 42)nmol/L and (0. 48 ± 0 .05)mg/L respectively, where- as were significant increased in NP group(1 .05 ± 0 .69)nmol/L and (0 .63 ± 0.11)mg/L, respectively. Conclusion Normal gestation is associated with a deceased APC sensitivity ratio, which may be related to the increase of LA level during during and resulted in a marked activation of coagulation / fibrinolysis system, indicating a pregnancy-related hypercoagulabe state existing in normal preg- nancy or with a risk of thrombotic complication.