妊娠高血压疾病纤溶及凝血指标的变化及临床意义

Changes and clinical significance of fibrinolytic and blood coagulation indexes in cases of pregnancy-induced hypertension disease

目的分析妊娠高血压疾病纤溶及凝血指标的变化及临床意义。方法选取浙江省湖州市长兴县人民医院妇产科自2012年9月至2015年9月收治的253例妊娠期高血压疾病患者,其中轻度子痫前期组患者84例,重度子痫前期组患者89例,妊娠期高血压组患者80例,另选择同时期经体检收治的正常妊娠组孕妇82例,比较两组患者的血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-D二聚体(DD)、组织纤溶酶原激活物(t PA)、纤溶酶原激活抑制物-1(PAI-1)活性。结果妊娠期高血压疾病组较正常妊娠组相比PT、APTT较低,FIB、DD、PAI-1较高,具有显著差异(t值分别为5.65、7.54、7.67、6.38、6.35,均P<0.05)。妊娠期高血压疾病组与正常妊娠组相比t PA无明显差异(t=0.87,P>0.05)。轻度子痫前期组与妊娠期高血压组相比PT、APTT、FIB、t PA均无明显差异(t值分别为0.61、0.73、0.62、0.81,均P>0.05),轻度子痫前期组较妊娠期高血压组相比DD、PAI-1升高,具有显著差异(t值分别为5.56、5.23,均P<0.05),重度子痫前期组较轻度子痫前期组相比,PT、APTT显著降低(t值分别为4.26、3.91,均P<0.05),FIB、DD、PAI-1显著升高(t值分别为5.11、5.56、6.12,均P<0.05)。结论检测妊娠期孕妇的纤溶及凝血指标,对有效预防并治疗妊娠期高血压疾病的发生与发展有重要临床意义。

Objective To analyze the changes and clinical significance of fibrinolytic and blood coagulation indexes in cases of pregnancyinduced hypertension. Methods Totally 253 cases of pregnancy-induced hypertension were selected from People＇s Hospital of Changxing County in Zhejiang Province during September 2012 to September 2015,including 84 cases in mild preeclampsia group,89 cases in severe preeclampsia group,and 80 cases in gestational hypertension group. Another 82 cases of normal pregnancy were selected in control group.Prothrombin time（ PT）,activated partial thromboplastin time（ APTT）,fibrinogen（ FIB）,D-D dimer（ DD）,tissue plasminogen activator（ t PA）,plasminogen activator inhibitor-1（ PAI-1） activity were compared among groups. Results Compared to normal pregnancy group,gestational hypertension group had lower PT and APTT but higher FIB,DD and PAI-1with significant differences（ t value was 5. 65,7. 54,7. 67,6. 38 and 6. 35,respectively,all P〈0. 05）. There was no obvious difference in t PA between gestational hypertension group and normal pregnancy group（ t = 0. 87,P〉0. 78）. PT,APTT,FIB and t PA of mild preeclampsia group were not obviously different from those of gestational hypertension group（ t value was 0. 61,0. 73,0. 62 and 0. 81,respectively,all P〉0. 05）,but DD and PAI-1 were higher in mild preeclampsia group with significant differences（ t value was 5. 56 and 5. 23,respectively,both P〈0. 05）. Severe preeclampsia group had relatively lower PT and APTT but higher FIB,DD and PAI-1 than mild preeclampsia group（ t value was 4. 26,3. 91,5. 11,5. 56 and 6. 12,respectively,all P〈0. 05）. Conclusion Detecting fibrinolytic and coagulation indexes of pregnant women is of great important for effective prevention and treatment of pregnancy-induced hypertension disease.