复发性自然流产患者血栓标志物及其诊断界限值的研究

Study on thrombus markers and their diagnostic threshold in patients with recurrent spontaneous abortion

目的筛选对复发性自然流产(recurrent spontaneous abortion,RSA)患者的早期诊断和干预有提示意义的血栓标志物。方法收集2012年10月至2014年10月在郑州人民医院妇产科就诊的RSA患者(排除由遗传因素、生殖器畸形等原因造成的复发性流产者)86例流产前和176例正常孕妇的6种血栓标志物[抗凝血酶Ⅲ(antithrombinⅢ,ATⅢ)、蛋白C(Protein C,PC)、纤溶酶原(plasminogen,PLG)、组织型纤溶酶原激活物(tissue plasminogen activator,t_PA)、纤溶酶原激活物抑制因子-1(plasminogen activatorinh ibitor-1,PAI-1)、交联纤维蛋白(cross-linked fibrin,CLFb)的降解产物,D-二聚体(D-dimer,D-D)]进行对比研究,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),并进行Logistic回归分析。结果根据ROC曲线图,AT、PC、PAI-1 3个血栓标志物曲线下面积分别为0.712、0.927、0.984,都>0.5,具有诊断价值;PLG、t_PA、DD 3个指标曲线下面积太小,证明其灵敏度和特异性不够好。Logistic回归分析,3个指标的判别准确率分别为82.8%、96.6%和94.7%,Sig值均<0.01,差异有统计学意义。结论 AT、PC、PAI-1这3种标志物对RSA有更灵敏的提示作用。当其检测值高于其诊断界限值时,可作为孕妇血栓处于异常状态且有自然流产可能的参考。

Objective To screen out thrombus markers with the significance on suggesting the early diagnosis and intervention of recurrent spontaneous abortion（RSA） patients. Methods Levels of 6 thrombus markers [ antithronmbin III （AT -III）, protein C （PC）, plasminogen （ PLG）, tissue plasminogen activator （ t_ PA）, plasminogen activator inhibitor - 1 （ PAl - 1 ） and fibrin degradation products D -Dimer （DD） ] of 86 RSA patients before their abortion and of 176 normal gravidas in People＇s Hopsital of Zhengzhou from November 2012 to Novemben 2014 were analyzed contrastively. Then receiver operator characteristic （ROC） curves were drawn and Logistic regression analysis was conducted. Results According to ROC curve, areas under curve（AUC） of AT, PC and PAI- 1 were 0.712, 0.927 and 0. 984 respectively, which were more than 0.5, indicating diagnostic value; while AUCs of PLG, t_PA and DD were too small, suggesting poor sensitivity and specificity. Through Logistic regression analysis, the accuracy rates of the 3 indexes were 82.8 %, 96.6 % and 94.7 % respectively, and all of their Sig values were less than 0.01 with statistical significance. Conclusion AT, PC and PAI- 1 are more sensitive implications for RSA. In addition, when detection values of these 3 indicators are respectively more than diagnostic limits, it suggests that thrombus of gravida was in abnormal conditions with risk of RSA.