高原与零海拔区域复发性流产的血栓前状态分析

Analysis the prethrombotic state of recurrent spontaneous abortion in the plateau and zero altitude areas

目的分析比较零海拔及高原两个不同区域血栓前状态(PTS)在复发性自然流产(RSA)中的权重,为RSA尤其高原地区RSA西医抗凝及中医活血化瘀治疗提供理论依据。方法选取2012年1月~2016年12月于广州中医药大学深圳医院住院的RSA(≤10周)妇女60例及住院终止妊娠的正常(≤10周)妇女108例,分别设为零海拔RSA组和零海拔正常组。选取同期于新疆塔什库尔干县人民医院住院的RSA(≤10周)妇女40例及住院终止妊娠的正常(≤10周)妇女52例,分别设为高原RSA组和高原正常组。分别对各组病例测定凝血酶原时间(PT)、部分凝血活酶(APTT)、凝血酶时间(TT)、纤维蛋白原(Fbg)含量及血小板(PLT)、血细胞比容(HCT)的值,并进行比较分析。结果与零海拔正常组比较,零海拔RSA组PT显著降低,Fbg、HCT显著增高(P<0.01),APTT、TT有所下降(P<0.05),PLT稍下降,但差异无统计学意义(P>0.05);高原正常组与零海拔正常组比较,PT、TT、APTT均显著降低(P<0.01),Fbg、HCT显著增高(P<0.01),PLT有所下降(P<0.05);高原RSA组与高原正常组比较,PT显著降低(P<0.01),Fbg显著增高(P<0.01),PLT稍下降,但差异无统计学意义(P>0.05),APTT、TT有所下降(P<0.05),HCT有所增高(P<0.05);高原RSA组与零海拔RSA组比较,PT、TT、APTT均显著降低(P<0.01),Fbg、HCT均显著增高(P<0.01),PLT稍下降,但差异均无统计学意义(P>0.05)。结论无论高原或零海拔RSA(≤10周)妇女血液均处于高凝状态,但以高原RSA为甚,高原RSA妇女再次妊娠应加强抗凝治疗,从而改善高原地区妇女生育状态。

Objective To analyze and compare the prethrombotic state（PTS） of RSA in the plateau areas and the zero altitude areas, to provide a theoretical basis of Western anticoagulant thera py and traditional Chinese medicine for blood circulation treatment for the RSA, particulary in the plateau areas. Methods From January 2012 to December2016, 60 women with RSA（≤10 weeks） and 108 women with normal early pregnancy（≤10 weeks） who were hospitalized for termination of pregnancy at Shenzhen University Hospital of Guangzhou University of Traditional Chinese Medicine were selected as the Zero altitude areas RSA group and the Zero altitude areas normal group, 40 women with RSA（≤10 weeks） and 52 women with normal early pregnancy（≤10 weeks） who were hospitalized for termination of pregnancy at the same peroid in the People′s Hospital of Taxkorgan County in Xinjiang Uygur Autonomous Region were selected as the plateau areas RSA group and the plateau areas normal group. The prothrombin time（PT）, partial thromboplastin time（APTT）, thrombin time（TT）, fibrinogen content（Fbg） and platelet（PLT）, hematoc rit（HCT） were deter-mined for each group of case and compared. Results The RSA group compared with the normal group in thezero altitude areas, PT decreased significantly, Fbg and HCT increased significantly（P 〈 0.01）, APTT and TT decreased（P 〈 0.05）, and PLT decreased slightly（P 〉 0.05）. The normal group in the plateau areas compared with the normal group in the zero altitude areas, PT, TT and APTT were significantly lower（P 〈 0.01）. while the levels of Fbg and HCT were significantly increased（P 〈 0.05）, and PLT decreased slightly（P 〉 0.05）. The RSA group Compared with the normal groupin the plateau areas, PT was significantly lower（P 〈 0.01）, Fbg was significantly higher（P 〈 0.01）, PLT slightly decreased,（P 〉 0.05）, APTT and TT decreased（P 〈 0.05）, HCT increased（P 〈 0.05）. The RSA group in the plateau areas, compared with the RSA group in the zero altitude areas, PT, TT and APTT were significantly lower（P 〈 0.01）,Fbg and HCT were significantly increased（P 〈 0.01）, PLT slightly decreased（P 〉 0.05）. Conclusion Both the zero alti tude areas and the plateau areas RSA groups（≤ 10 weeks） women′s blood are in a state of hypercoagulability, but the RSA group in the plateau areas are especially obvious. The RSA group women in the plateau areas should strengthen anticoagulant therapy for the next pregnancy in order to improve the fertility status.