早孕期稽留流产影响因素分析  

Analysis of influencing factors of missed abortion in early pregnancy

作　　者：许雅娟[1] 余艳茹 班彦杰 柳蕊[1] 洪腾[1] 翟闪闪[1] 任利单 冉利敏 Xu Yajuan;Yu Yanru;Ban Yanjie;Liu Rui;Hong Teng;Zhai Shanshan;Ren Lidan;Ran Limin(Department of Obstetrics,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院产科,河南郑州450052

出　　处：《河南医学研究》2018年第17期3093-3097,共5页Henan Medical Research

摘　　要：目的探讨早孕期稽留流产与叶酸、同型半胱氨酸(Hcy)、维生素B12(Vit B12)、蛋白C(PC)活性、蛋白S(PS)活性、抗凝血酶Ⅲ(ATⅢ)活性的关系。方法选取2016年6月至2017年11月就诊于某医院诊断为稽留流产的80例早孕期妊娠期妇女纳入稽留流产组,同孕期正常围保的80例妊娠妇女纳入正常妊娠组。采用直接化学发光法测定研究对象外周血血清叶酸、Vit B12及Hcy水平;采用显色性合成底物法测定PC、ATⅢ活性;采用凝固法测定PS活性。采用单因素和Logistic回归分析稽留流产发生的可能相关因素,评估Hcy、PC、PS、ATⅢ对稽留流产的预测价值,分析血清叶酸、Vit B12、Hcy、PC活性、PS活性、ATⅢ活性的相关性。结果稽留流产组血清叶酸水平、PC活性、PS活性和ATⅢ活性均低于正常妊娠组,差异有统计学意义(P <0. 05);稽留流产组血清Hcy水平高于正常妊娠组,差异有统计学意义(P <0. 05);两组Vit B12水平比较,差异无统计学意义(P> 0. 05)。Hcy、PC、PS、ATⅢ是稽留流产发生的危险因素;稽留流产组血清Hcy水平与血清叶酸、Vit B12水平和PC活性呈负相关,PC活性与ATⅢ活性呈正相关(P <0. 05);正常妊娠组血清叶酸、Vit B12、Hcy、PC、PS和ATⅢ之间无相关性(P>0. 05),Hcy、PS、PC、ATⅢ诊断稽留流产ROC曲线下面积分别为0. 735、0. 741、0. 775、0. 720(P <0. 05)。结论 Hcy、PC、PS、ATⅢ可能参与稽留流产的发生,叶酸和Vit B12可能与稽留流产的发生无相关性。Objective To explore the correlation between early pregnant women with missed abortion and serum levels of folic acid, Homocysteine （Hcy）,Vitamin B 12 （VitB 12 ） and protein C（PC） activity, protein S（PS） activity, antithrombin Ⅲ（ATⅢ） activity.Methods A total of 80 early pregnant women diagnosed as missed abortion and 80 the same gestational ages who were admitted to a hospital from June of 2016 to November of 2017 were studied for missed abortion group and normal pregnancy group, respectively. The serum levels of folic acid, Hcy and VitB 12 in peripheral blood were determined by direct chemiluminescence assay and enzymatic assay. The PC and ATⅢ were measured with freezing method. The PS was measured with chromogenic substrate- synthesis. The correlative factors of missed abortion were analyzed with Univariate and Logistic regression analysis. The predictive value of Hcy、PC、PS、ATⅢ in missed abortion were estimated. The correlation of the folic acid, Hcy, VitB 12 , PC, PS and ATⅢ were studied as well.Results The serum folic acid, PC, PS and ATⅢ in missed abortion group were lower than those in normal pregnancy group（ P 〈0.05 ）. The serum Hcy in missed abortion group was higher than those in normal pregnancy group（ P 〈0.05 ）. There was no significantly difference in the serum levels of VitB 12 between the missed abortion group and normal pregnancy group （ P 〉0.05 ）. Hcy, PC, PS, ATⅢ were dangerous factors of missed abortion（ P 〈0.05 ）. The Hcy level in missed abortion group was negatively correlated to the levels of folic acid, VitB 12 and PC, and the activity of PC were positively correlated to the activity of ATⅢ（ P 〈0.05 ）. There were no correlation between folic acid, VitB 12 , PS, PC and ATⅢ in normal pregnancy group （ P 〉0.05 ）. The area under the ROC curve of serum levels of Hcy, and the activity of PS, PC, ATⅢ in diagnosing missed abortion were 0.735, 0.741, 0.775, 0.720, respectively （ P 〈0.05 ） .Conclusion Hcy, PC,

关 键 词：叶酸 同型半胱氨酸 维生素B 12 蛋白C活性 蛋白S活性 抗凝血酶Ⅲ活性 稽留流产 

分 类 号：R714.21[医药卫生—妇产科学]