妊娠妇女凝血-抗凝与纤溶测定的临床意义

Clinical Significance of Coagulation-Anticoagulant and Fibrinolytic in Pregnance Woman

目的:检测妊娠妇女和妊高征患者凝血与纤溶的变化,探讨孕妇在不同状态下各项指标的临床意义。方法:将63例妊娠妇女分为正常孕妇组43例和妊高征20例,采用磁珠凝固法检测凝血酶原时间(PT)、部分活化凝血酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fbg)和游离蛋白S(FPS);免疫比浊法检测D-二聚体(D-D)、血管性血友病因子(vWF),并与非孕妇的健康对照组作比较。结果:43例孕妇和20例妊高征患者血浆PT、APTT、均显示不同程度的缩短;TT延长率在妊娠组仅为1％,而妊高征为18％;两组Fbg水平增高明显;妊娠组FPS与对照组比较差异无显著性,但妊高征患者表现明显降低;两组D-D水平均增高,且妊高征患者明显增高;妊娠组vWF水平与对照组比较尽管差异无显著性,但仍有3例高于对照组;妊高征患者增高率达100％。结论:妊娠妇女与妊高征患者均存在不同水平的凝血活化、纤溶亢进和内皮细胞一定程度的损伤,妊娠期作凝血-抗凝、纤溶指标的检测,对预防出血,降低DIC等的发生率具有指导意义。

Objective: To test the variation of coagulation-fibrinolytic system in the pregnancy women and pregnancy - induced hypertension women(PIH) ,explore the application of coagulation firinolytic system markers in the pregnancy women. Methods: 63 pregnancy women were divided into two groups: 43 cases of the narmal prgancy women and 20 PIH, according to chnical conditions. The plasma levels of prothrombin time(PT) , activated partial thrombin time(APTT) ,thrombin (TT),fibrinogcn(Fbg) ,free protein S (FPS) were detected by clotting method, D-Dimer (D-D) and vWF by iimmunoturbidity on the coagulation analyzer. Results: In two groups the levels of PT, APTT were signifcantly shorter. The rate of the prolong TT were found in 18% of PIH while only in 1% of the normal pregnancy women; Fbg in two groups showed higher significandy than that in the control group. There are no significant defferenccs plasma level of FPS between the normal pregnancy and the control group but FPS in PIH decreased clearly . A significant change of vWF in two groups were observed , especially in the patients with PIH. Conclusion: The normal pregnancy women and PIH are assoicated with marked activation of coagulation-frobrinolytic endotheliam damage to a certain extent . These markers are useful to evaluate the coagulation-fribrinolytic level of the pregancy women, predict bleeding and protect DIC.