血栓前状态标志物TAT、蛋白S及D-Dimer在妊娠高血压疾病孕妇中的水平及临床意义

Levels and clinical significances of TAT,Protein S and D-Dimer of thrombophilia in pregnant women with HDP

目的分析凝血酶-抗凝血酶III复合物(TAT)、蛋白S(PS)和D-Dimer等血栓前指标在妊娠高血压疾病孕妇中的水平及临床意义。方法回顾性分析2022年1月-2023年11月首都医科大学附属北京同仁医院收治的53例妊娠高血压疾病患者(HDP组)资料,另选同期正常妊娠孕妇62例(正常孕妇组),比较两组间TAT、蛋白S和D-Dimer等指标之间的差异,及其母婴结局。采用Pearson分析法分析TAT、蛋白S和D-Dimer与妊娠高血压疾病的相关性,并采用受试者工作特征(ROC)曲线分析TAT和孕晚期D-Dimer对妊娠高血压疾病发生的预测效能。结果HDP组的血栓前指标TAT和孕晚期D-D值均高于正常孕妇组,具有统计学意义(P<0.05),HDP组蛋白S值低于正常孕妇组,具有统计学意义(P<0.05)。TAT、蛋白S和孕晚期D-Dimer对妊娠高血压疾病的发生具有较好的预测效能,三项指标联合检测的灵敏度为0.61,特异度为0.86,曲线下面积(AUC)为0.758,优于各指标单独检测。HDP组剖宫产、胎盘梗死、眼底病变、妊娠糖尿病的发生率显著高于正常孕妇组,差异具有显著性(P<0.05)。HDP组低体重儿和早产儿的发生率高于正常孕妇组,具有统计学意义(P<0.05)。结论TAT、蛋白S和孕晚期D-D水平与妊娠高血压疾病的发生密切相关,对妊娠高血压疾病的诊断具有重要意义。

Objective To investigate the levels and clinical significances of TAT,Protein S and D-dimer of thrombophilia in pregnant women with HDP.Methods A total of 53 patients with hypertensive disorders of pregnancy(HDP group)admitted to our hospital from January 2022 to November 2023 were retrospectively analyzed.Another selection of 62 normal pregnancy women during the same period were made the normal group(normal pregnant woman group).To compare the differences of TAT,Protein S and D-Dimer,as well as maternal and infant outcomes between the two groups.Pearson analysis was used to analyze the correlation between TAT,protein S and D-Dimer and gestational hypertensive disorders,and the receiver operating characteristic(ROC)curve was used to analyze the predictive performance of TAT and D-Dimer in the third trimester for the occurrence of gestational hypertensive disorders.Results The levels of prethrombotic index TAT and D-Dimer in the third trimester of the HDP group were significantly higher than the normal pregnant woman group(P<0.05).Meanwhile the level of Protein S of HDP was significantly lower than the normal pregnant woman group(P<0.05).TAT,protein S and D-Dimer in the third trimester of pregnancy had good predictive performance in the occurrence of hypertensive diseases in pregnancy,and the sensitivity of the three indicators was 0.61,the specificity was 0.86,and the area under the curve(AUC)was 0.758,which was better than that of each index alone.The incidence of caesarean section,fundus lesions,placental infarction,gestational diabetes mellitus in the HDP group were significantly higher than those in the normal pregnant woman group(P<0.05);the incidence of low birth weight and premature delivery in the HDP group were significantly higher than those in the normal pregnant woman group(P<0.05).Conclusion TAT,protein S and D-D levels in late pregnancy are closely related to the occurrence of hypertensive disorders in pregnancy,which are of great significance for the diagnosis of hypertensive disorders in pregnancy.