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目的检测凝血、抗凝和纤溶实验室指标,探讨其在正常妊娠晚期、子痫前期孕妇中的变化及与母儿并发症的关系。方法检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、抗凝血酶Ⅲ(AT-Ⅲ)、D-D二聚体(D-D),组织纤溶酶原激活物(tPA)、纤溶酶原激活抑制物-1(PAI-1)等7项凝血、抗凝、纤溶实验室指标共166例,其中非孕妇女40例,正常妊娠晚期孕妇40例,轻度子痫前期42例,重度子痫前期44例,并对检测结果进行比较分析;同时分析止凝血指标与母儿并发症之间的关系。结果与非孕妇女组比较,正常妊娠晚期组PT、APTT、TT、AT-Ⅲ明显降低(P<0.01或P<0.05),D-D、tPA、PAI-1明显升高(P<0.01或P<0.05);与正常妊娠晚期组比较,子痫前期组PT、APTT、AT-Ⅲ明显降低(P<0.01或P<0.05),随着疾病进展差异越显著,D-D、PAI-1明显升高(P<0.01),随着疾病的进展指标升高越明显,而TT、tPA在各组间无显著性差异;与无母儿并发症组比较,存在母儿并发症组AT-Ⅲ明显降低(P<0.05),D-D、PAI-1明显升高(P<0.01),其他实验室指标在两组间比较无显著性差异。结论正常妊娠晚期孕妇血液处于高凝状态,子痫前期患者处于异常高凝状态,有血栓形成倾向。检测凝血、抗凝、纤溶实验室指标,对早期预防、诊断、监测和治疗子痫前期的发生、发展及降低孕产妇及围生儿死亡率具有重要的临床意义。
Objective To detect the laboratory indexes of coagulation, anticoagulation and fibrinolysis to investigate the changes in pregnant women with normal pregnancy and pregnant women with preeclampsia and their relationship with maternal and child complications. Methods The serum levels of PT, APTT, TT, AT-III, DD, DD, A total of 166 coagulation, anticoagulant and fibrinolytic laboratory markers, including tPA, PAI-1, were included in the study, including non-pregnant women (40 cases) and normal pregnant women Cases, 42 cases of mild preeclampsia, 44 cases of severe preeclampsia, and comparative analysis of test results; at the same time analysis of the relationship between blood coagulation and maternal and child complications. Results Compared with non-pregnant women, the levels of PT, APTT, TT and AT-Ⅲ were significantly decreased (P <0.01 or P <0.05) and the levels of DD, tPA and PAI- 0.05). Compared with the normal pregnancy group, the levels of PT, APTT and AT-Ⅲ in preeclampsia group were significantly lower (P <0.01 or P <0.05) P <0.01). With the progress of disease index increased more obviously, but TT and tPA had no significant difference between the groups. Compared with the group without maternal complications, there was a significant decrease of AT-Ⅲ in the group of maternal and child complications P <0.05), DD, PAI-1 were significantly increased (P <0.01), other laboratory parameters in the two groups showed no significant difference. Conclusion The blood of pregnant women in the third trimester of pregnancy is in hypercoagulable state, and the patients with preeclampsia are in abnormal hypercoagulable state with thrombosis tendency. Detection of coagulation, anticoagulation, fibrinolysis laboratory indicators for the early prevention, diagnosis, monitoring and treatment of preeclampsia, development and reduce maternal and perinatal mortality has important clinical significance.