纵向序贯研究正常妊娠高凝状态时纤溶系统活性的变化

doi:10.3969/j.issn.1673-8640.2016.01.004

摘要/Abstract

摘要： 目的探讨汉族人群正常妊娠生理性高凝状态时原发性纤溶系统活性的变化。方法采用纵向序贯研究,纳入孕期及妊娠结局均正常的孕妇（正常妊娠组）100名,以同期进行健康体检的100名育龄期妇女作为非孕对照组。检测正常孕期妇女常规纤溶指标[纤维蛋白原（Fg）、纤维蛋白原降解产物（FDP）、Fg/FDP比值]及纤溶调节指标[组织型纤溶酶原激活物（t-PA）、纤溶酶原激活物抑制剂-1（PAI-1）含量和t-PA/PAI-1比值]的变化,分析Fg、FDP与t-PA/PAI-1比值的相关性。结果正常妊娠组Fg、FDP水平及Fg/FDP随孕期增加逐渐升高（P<0.01）;与非孕对照组相比,正常妊娠组各孕期t-PA、PAI-1、t-PA/PAI-1比值均增高（P<0.05）。正常妊娠组早孕时t-PA/PAI-1比值与Fg呈正相关[（r）=0.81,P<0.05];t-PA/PAI-1比值在中孕时降到最低（即Fg降解率达到最低）,Fg在晚孕时达到高峰。正常妊娠组孕早、晚期t-PA/PAI-1比值与FDP均呈正相关（r分别为0.75及0.79,P<0.05）。结论汉族人群正常妊娠时机体并未启动凝血。机体在整个妊娠期通过增强原发性纤溶活性直接控制升高的Fg含量,在高水平上使凝血/纤溶系统保持平衡。

关键词: 纤溶系统, 妊娠, 纤维蛋白原, 组织型纤溶酶原激活物, 纤溶酶原激活物抑制剂-1

Abstract:

Objective To investigate the changes of fibrinolytic activity during normal pregnancy for hypercoagulation in Chinese Han population. Methods A total of 100 healthy pregnant women（healthy pregnant group） and 100 healthy unpregnant women（unpregnant control group） were enrolled in the longitudinal study. Fibrinogen（Fg）,fibrin degradation product（FDP）,Fg/FDF ratio,tissue-type plasminogen activator（t-PA）,plasminogen activator inhibitor -1（PAI-1） and t-PA/PAI-1 ratio were evaluated. The correlations of Fg and FDP with t-PA/PAI-1 were analyzed. Results Fg,FDP and Fg/FDP ratio increased with the period of pregnancy（P<0.01）. Compared with unpregnant control group,t-PA,PAI-1 and t-PA/PAI-1 ratio increased in healthy pregnant group（P<0.05）. t-PA/PAI-1 ratio and Fg were positively related during early pregnancy [correlation coefficient （r）=0.81,P<0.05],and t-PA/ PAI-1 ratio was the lowest during middle pregnancy（the degradation rate of Fg was the lowest）. Fg increased significantly during late pregnancy and reached the highest level. The correlation between t-PA/PAI-1 ratio and FDP was positive during early and late pregnancy（r=0.75 and 0.79,P<0.05）. Conclusions In Chinese Han population,their bodies do not trigger coagulation during normal pregnancy. The bodies controls directly elevated Fg by increasing primary fibrinolytic activity,and coagulation / fibrinolysis system maintains balance on high level .

Key words: Fibrinolysis system, Pregnancy, Fibrinogen, Tissue-type plasminogen activator, Plasminogen activator inhibitor-1

中图分类号:

R446.11

王月芳, 石华, 岳新爱, 江咏梅. 纵向序贯研究正常妊娠高凝状态时纤溶系统活性的变化[J]. 检验医学, 2016, 31(1): 17-21.

WANG Yuefang, SHI Hua, YUE Xinai, JIANG Yongmei. Longitudinal study on fibrinolytic activity changes during normal pregnancy for hypercoagulation[J]. Laboratory Medicine, 2016, 31(1): 17-21.

图/表 6

参考文献 18

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组别	例数	年龄	孕前体重指数（kg/m²）	基础血压（kPa）		孕10~14周
组别	例数	年龄	孕前体重指数（kg/m²）	收缩压	舒张压	孕周（周）	收缩压（kPa）	舒张压（kPa）
正常妊娠组	100	30.5±3.1	20.9±2.4	—	—	13.1±1.4	14.0±1.5	9.2±1.3
非孕对照组	100	29.5±3.9	19.9±2.3	14.3±1.2^*	8.5±1.2^*	—

组别	例数	年龄	孕前体重指数（kg/m²）	基础血压（kPa）		孕10~14周
组别	例数	年龄	孕前体重指数（kg/m²）	收缩压	舒张压	孕周（周）	收缩压（kPa）	舒张压（kPa）
正常妊娠组	100	30.5±3.1	20.9±2.4	—	—	13.1±1.4	14.0±1.5	9.2±1.3
非孕对照组	100	29.5±3.9	19.9±2.3	14.3±1.2^*	8.5±1.2^*	—

组别	孕20~24周			孕30~34周
组别	孕周（周）	收缩压（kPa）	舒张压（kPa）	孕周（周）	收缩压（kPa）	舒张压（kPa）
正常妊娠组	22.7±2.0	14.9±1.3	9.4±1.0	33.2±3.1	15.2±1.2	9.7±1.0
非孕对照组	—	—	—	—	—	—

组别	孕20~24周			孕30~34周
组别	孕周（周）	收缩压（kPa）	舒张压（kPa）	孕周（周）	收缩压（kPa）	舒张压（kPa）
正常妊娠组	22.7±2.0	14.9±1.3	9.4±1.0	33.2±3.1	15.2±1.2	9.7±1.0
非孕对照组	—	—	—	—	—	—

组别	分娩时孕周（周）	产后12~16周		胎盘重量（g）	分娩时出血量（mL）
组别	分娩时孕周（周）	收缩压（kPa）	舒张压（kPa）	胎盘重量（g）	剖宫产	自然分娩
正常妊娠组	38.4±1.5	14.3±1.3	9.5±1.1	519±92	274	160
非孕对照组	—	—	—	—	—	—