健康妇女孕期抗凝指标的变化

Changes of anticoagulant parameters in healthy women during pregnancy

目的研究正常妊娠妇女血浆抗凝血酶Ⅲ(AT-Ⅲ)、蛋白C(PC)、蛋白S(PS)的活性在不同孕期的变化及临床意义。方法收集正常非孕妇(对照组90例)和正常妊娠妇女(552例),其中正常妊娠妇女组分为3个亚组,早孕组(150例)、中孕组(153例)和晚孕组(249例)。应用发色底物法检测AT-Ⅲ、PC活性,凝固法检测PS活性并对结果进行分析。结果与对照组比较,早孕组、中孕组、晚孕组妇女AT-Ⅲ活性差异有统计学意义(P<0.01),各孕组间差异无统计学意义(P>0.05)。与对照组相比,早孕组的PC活性降低(P<0.001),在孕中期和孕晚期升高(P<0.001);PS活性显著低于正常对照(P<0.01),各孕组之间差异有统计学意义(P<0.01)。进一步线性相关分析发现,PC活性与孕周数呈显著正相关(r=0.531,P<0.001),而PS活性与孕周数呈显著负相关(r=-0.393,P<0.001)。结论与正常妇女相比,妊娠妇女PC、PS活性指标发生显著变化,且整个孕期呈现动态变化,为产科医生对孕妇孕期的血栓风险的评估提供了一定的依据。

Objective To observe the changes and the diagnostic values of activity for plasma antithrombin-Ⅲ( AT-Ⅲ), protein C( PC),protein S( PS) of pregnant women at various gestational ages. Methods The normal non-pregnant group ( 90 subjects for control group) and the normal pregnant women group ( 552 subjects) were enrolled in this clinical trial,including 150 for first trimester,153 for second trimester,249 for third trimester. The activity of AT -Ⅲ and PC was detected by chromogenic substrate method,and the PS activity was detected by coagulation method and the results were analyzed. Results The activity of AT -Ⅲ in the subjects of first,second and third trimester was significantly variant compared with control group,and the difference was statistically significant ( P < 0. 01 ),and there was no statistical significance on the differences among different gestational ages ( P > 0. 05). Compared with control group,the activity of PC in the first group was significantly lower ( P < 0. 001),second and third trimester groups was significantly higher ( P < 0. 001). But the activity of PS was significantly lower compared with control group,and the differences were statistically significant among subgroups ( P < 0. 01). The activity of PC was positively correlated with pregnant weeks ( r = 0. 531,P < 0. 001),but the activity of PS was negatively correlated with pregnant weeks ( r =-0. 393,P < 0. 001). Conclusion Compared with the normal non-pregnant women,the activity index of PC,PS for normal pregnant women showed significant changes,and the whole pregnant presented dynamic changes, which can provide basis for obstetrician to assess the risks during pregnancy.