D-Dimer、AT-Ⅲ、t-PA、PAI-1水平对复发性流产患者血栓前状态的诊断价值  

Diagnostic Value of D-Dimer,AT-Ⅲ,t-PA and PAI-1 for Prethrombotic State in Patients with Recurrent Miscarriage

作　　者：汪艳丽[1] 熊亮[2] 张静[2] 

机构地区：[1]湖北省天门市妇幼保健院检验科,天门431700 [2]华中科技大学同济医学院附属梨园医院检验科,武汉430077

出　　处：《微循环学杂志》2016年第3期27-30,共4页Chinese Journal of Microcirculation

基　　金：湖北省自然科学基金(2015CFB656)

摘　　要：目的:分析D-二聚体(D-Dimer)、抗凝血酶Ⅲ(AT-Ⅲ)、组织型纤溶酶原激活物(t-PA)和纤溶酶原激活抑制剂-1(PAI-1)水平变化对复发性流产(RSA)患者血栓前状态的诊断价值。方法:选择RSA患者80例为RSA组,按流产次数分为流产3次组、4次组和>4次组三个亚组,另选健康体检未孕者86例为对照组,检测各组血浆D-Dimer水平、AT-Ⅲ活性、血清t-PA及PAI-1浓度。比较RSA组和对照组及三个亚组间各指标差异。并应用ROC曲线评价各指标对RSA患者血栓前状态的诊断价值。结果:RSA组血浆D-Dimer、血清t-PA、PAI-1水平均明显高于对照组(P<0.01),血浆AT-Ⅲ活性明显低于对照组(P<0.01)。流产>4次组血浆D-Dimer、血清tPA、PAI-1水平均明显高于流产3次组和流产4次组(P<0.01),血浆AT-Ⅲ活性低于流产3次组和流产4次组(P<0.01)。流产4次组血浆D-Dimer、血清t-PA、PAI-1水平均明显高于流产3次组(P<0.01),血浆AT-Ⅲ活性低于流产3次组(P<0.01)。血浆D-Dimer、AT-Ⅲ、血清t-PA、PAI-1诊断RSA血栓前状态的最佳临界值分别为1.51mg/L、92.62%、11.72ng/ml、35.55ng/ml。血浆D-Dimer、AT-Ⅲ、血清t-PA、PAI-1曲线下面积(AUC)分别为0.781、0.795、0.769、0.722,灵敏度分别为62.50%、82.50%、60.00%、76.20%,特异度分别为74.40%、68.60%、81.20%、59.30%。结论:血栓前状态与RSA有关,检测血浆D-Dimer、AT-Ⅲ、血清t-PA、PAI-1水平有助于RSA血栓前状态的筛查。Objective：To analyze the changes of D-Dimer,AT-Ⅲ,t-PA,PAI-1level and the diagnostic value of those indicators for prethrombotic state in patients with recurrent miscarriage.Method：80women with recurrent spontaneous abortion（RSA）were selected as RSA group.According to the frequency of abortion,RSA group was indived to abortion 3times,4times and〉4times subgroup.86 normal non-pregnant women as control group.The level of plasma D-Dimer,the activity of AT-Ⅲ,the concentrations of serum t-PA and PAI-1were detected.The differences of the above indicators between the two groups and the three subgroups were compared.ROC curve was used to assess he diagnostic value of these indicators for prethrombotic state in patients with recurrent miscarriage.Results：The levels of plasma D-Dimer,serum PAI-1and t-PA in RSA group were significantly higher than in control group（P〈0.01）.The activity of AT-Ⅲin RSA group was lower than in control group（P〈0.01）.The levels of D-Dimer,PAI-1and t-PA in abortion〉4times subgroup were significantly higher than in abortion 3times and 4times subgroup（P〈0.01）.The activity of AT-Ⅲ in abortion 〉4times subgroup was lower than in abortion 3times and 4times subgroup（P〈0.01）.The levels of D-Dimer,PAI-1and t-PA in abortion 4times subgroup were significantly higher than in abortion 3times subgroup（P〈0.01）.The activity of AT-Ⅲin abortion 4times subgroup was lower than in 3times subgroup（P〈0.01）.ROC curve analysis revealed that the optimal critical value of D-Dimer for prethrombotic state was 1.51mg/L,AT-Ⅲ was 92.62%,PAI-1was 35.55ng/ml,t-PA was 11.72ng/ml.Conclusion：The prethrombotic state was related to RSA.The area under the curve of D-Dimer,AT-Ⅲ,t-PA and PAI-1was 0.781,0.795,0.769,0.722,the sensitivity was 62.50%,82.50%,60.00%,76.20%,the specificity was 74.40%,68.60%,81.20%,59.30%.The detection of D-Dimer,AT-Ⅲ,t-PA and PAI-1was useful for screening of prethrombotic state in RSA.

关 键 词：复发性流产 血栓前状态 

分 类 号：R714.2[医药卫生—妇产科学] R446.11[医药卫生—临床医学]