不同孕期健康妊娠妇女血浆蛋白S水平及凝血指标的变化

Changes of plasma levels of protein S and coagulation factors in healthy women at different gestational ages

目的对不同孕期健康妊娠妇女蛋白S水平及凝血指标的变化进行初步研究。方法选择早、中、晚孕期健康初产妇各100例,另取50例非孕育龄期妇女为对照组。应用凝固法测定其出凝血酶原时间(PT),ELISA测定血浆蛋白S含量,发色底物法测定血浆中抗凝血酶Ⅲ(AT-Ⅲ)及蛋白S活性。对各组血浆蛋白S和各凝血指标进行统计学比较。结果妊娠中、晚孕期活化部分的凝血活酶时间(APTT)较非妊娠组下降,而纤维蛋白原(Fib)在早、中、晚孕三期较非妊娠组有明显升高,差异有统计学意义(P<0.05)。在整个孕期,AT-Ⅲ无明显变化,血浆总蛋白S(TPS)无改变,游离蛋白S(FPS)随着妊娠期逐渐减少,妊娠不同时期组间比较差异有统计学意义(F=11.326,P<0.01),且活性明显低于非妊娠妇女(P<0.01)。早、中、晚孕期蛋白S活性分别为(67.42±15.49)%,(57.91±14.40)%和(47.49±11.81)%,呈进行性下降(F=6.111,P=0.035)。结论在整个孕期,FPS逐渐减少,蛋白S活性逐渐降低,有利于孕期的高凝状态。

Objective To primarily investigate the changes of protein S and coagulation factors in the plasma of pregnant women at various gestational ages. Methods A total of 350 women were enrolled in this clinical trial including 100 each for the first, second and third trimester and 50 for non-pregnant healthy counterparts. The activity of protein S, antithrombin Ⅲ （AI-Ⅲ）, prothrombin time （PT）, activated partial thromboplastin time （AFFF） and fibrinogen （Fib） were measured and statistically compared among different groups. Results PT and APTT in the subjects of the second and third trimester were significantly shortened whereas Fib was significantly higher compared with than those in healthy controls （ both P 〈 0. 05 ）. Throughout the pregnancy, AT-Ⅲ did not vary significantly and total protein S remained unchanged. The level of free protein S （FPS） decreased gradually during pregnancy with a statistical significance among different groups （F = 11. 326, P 〈 0. 01 ）, significantly lower than that of non-pregnant healthy counterparts （P 〈 0. 01 ）. The activity of protein S decreased significantly with a mean level of （67.42 ± 15.49 ）%, （57.91 ± 14. 40 ）% and （47.49 ± 11.81 ） % during the first, second and third trimester （ F = 6. 111, P = 0. 035 ）. Conclusion The gradual decrease in both FPS level and protein S activity may play a role in maintaining a hypercoagulable state during pregnancy.