复发性自然流产患者血栓标志物的研究及其临界值的确定

Study of thrombus markers on recurrent spontaneous abortion and determination of the critical value

目的：研究复发性自然流产（Recurrent Spontaneous Abortion，RSA）患者血栓前状态的血栓标志物及其在病例组和对照组之间的最佳临界值。方法：收集郑州人民医院妇产科2012年10月至2014年10月就诊的连续自然流产两次及两次以上的RSA患者血栓标志物资料86例作为病例组，平均年龄（32.72±4.88）岁；同科室正常晚孕且孕周在13~16周之间的孕妇血栓标志物资料176例作为对照组，平均年龄（29.91±4.46）岁。检测抗凝血酶Ⅲ（ATˉⅢ）含量、蛋白C（PC）活性、纤溶酶原（PLG）含量、组织型纤溶酶原激活物（tˉPA）、纤溶酶原活化物抑制因子-1（PAIˉ1）、交联纤维蛋白降解产物（DD）6项血栓指标。采用SPSS 19.0绘制每个指标的ROC曲线，并确定其最佳临界值。采用Logistic回归分析判定指标的灵敏度和特异性。结果：ATˉⅢ、PC、PAIˉ1三个指标的ROC曲线下面积均在70%以上，具有诊断价值；AT的最佳界值为103.175，PC的最佳界值为5.785，PAIˉ1的最佳界值为0.725。三个指标的判别准确率分别为82.8%、96.6%和94.7%。p值均小于0.01，具有统计学意义。结论：ATˉⅢ、PC、PAIˉ1是复发性自然流产的危险因素，对其具有一定的诊断价值。

Objective： To explore the thrombus markers of patients with recurrent spontaneous abortion under prethrombotic state and to determine the best threshold between the case group and the control group. Methods： Eighty-six thrombus markers data of patients with RSA, who had consecutive spontaneous abortion twice or more and accepted treatment in the Obstetrics and Gynecology Department of Zhengzhou People＇s Hospital during October 2012 to October 2014, were collected as the case group, aged 32.72 4.88. Other 176 thrombus markers data of pregnant women, who belonged to normal late pregnancy throng and the gestational weeks was between 13 through 16 weeks, from the same department and aged 29.91 4.46 years old, were regarded as the control group. Six thrombus indexes, Antithrombin Ⅲ （ATˉⅢ）, Protein C activity （PC）, Plasminogen （PLG） level, tissue type plasminogen activator （tˉPA）, PAIˉ1 and DD, were tested. Then ROC curves of each index were drawn by means of SPSS 19.0 software and the best threshold was confirmed. The sensitivities and specificity of the indexes were tested by logistic regression analysis. Results： The area under ROC curves of ATˉIII, PC and PAIˉ1 were more than 70% and it has the diagnostic value. The optimum threshold of AT was 103.175, and that of PC was 5.785, and that of PAIˉI was 0.725. The accuracy was 82.8%, 96.6% and 94.7% respectively. P values of all indexes were lower than 0.01, which meant that it had statistical significance. Conclusion： ATˉⅢ, PC and PAIˉ1 are risk factors of recurrent spontaneous abortion and have certain diagnostic value in it.