孕妇孕晚期血浆t-PA和PAI-1对HND的预测价值  

Value of plasma t-PA and PAI-1 in later stages of pregnancy in prediction of HND

作　　者：禹梅[1] 张善弟 荆成宝[3] 李清华[1] 方晓蕾[1] Yu Mei;Zhang Shandi;Jing Chengbao;Li Qinghua;Fang Xiaolei(Department of Blood Transfusion,Ankang City Central Hospital,Ankang,Shaanxi,725000,China;Deparlment of Laboratory,the Second Hospital of Hanbin District,Ankang,Ankang,Shaanxi,725000,China;Department of Laboratory,Ankang City Central Hospital,Ankang,Shaanxi,725000,China)

机构地区：[1]安康市中心医院输血科,陕西安康725000 [2]安康市汉滨区第二医院检验科 [3]安康市中心医院检验科,陕西安康725000

出　　处：《西南国防医药》2018年第11期1032-1034,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探讨孕妇孕晚期血浆组织纤溶酶原激活物(t-PA)和组织纤溶酶原抑制物(PAI-1)对新生儿溶血病(HND)的预测价值。方法以76例夫妇血型不合的O型RhD(+)孕妇及其新生儿为研究对象,依据溶血3项检查和临床表现诊断为NHD新生儿30例,健康新生儿46例。比较健康与NHD新生儿及其母亲孕晚期血浆中t-PA、PAI-1及t-PA/PAI-1水平,并分别以健康新生儿母亲组t-PA、PAI-1和t-PA/PAI-1均值的95%可信区间上限值7.48μmol/L、50.46μg/L和0.19μmol/μg为临界值,分析t-PA、PAI-1及t-PA/PAI-1对HND的预测灵敏度、特异度和准确度。结果 NHD新生儿及其母亲的t-PA、PAI-1和t-PA/PAI-1均高于健康新生儿及其母亲(P <0.05)。孕晚期母体t-PA、PAI-1和t-PA/PAI-1各单项指标对HND的预测灵敏度均低于50%,准确度均低于60%,特异度均>70%上;但三者联合检测的灵敏度(56.67%)、特异度(86.96%)和准确度(75.00%)均高于各单项指标(P <0.05)。结论孕妇孕晚期t-PA、PAI-1和t-PA/PAI-1的升高对于预测HND有一定的提示作用,但各单项指标及联合检测的预测灵敏度均较低,仍需借助其他指标做更准确的判断。Objective To explore the value of plasma tissue plasminogen activator （t-PA） and plasminogenemia activator inhibitor （PAI-1） in later stages of pregnancy in the prediction of hemolytic disease of the newborn （HDN）. Method A total of 76 pregnant women with Upe 0 RhD （＋） and mismatched couple blood type and their newborns were selected. These newborns were diagnosed as HDN newborns （n =30） and healthy newborns （n =46） according to three hemolytic examinations and clinical manifestations. The levels of t-PA, PAI-1 and t-PA/PAI-1 in healthy and HDN newborns and their mothers in later stages of pregnancy were compared. The sensitivity-, specificity- and accuracy of t-PA, PAI-1 and t-PA/PAI-1 in the prediction of HDN were analyzed with the upper limit （95% confidenee interval） 7.48 μmol/L, 50.46 μg/L and 0.19 μmol/μg, of the average of the t-PA, PAI-1 and t-PA/ PAI-1 in healthy newborn and mother group as the critical value respectively. Results The t-PA, PAI-1 and t-PA/PAI-1 in HDN newborn and their mothers were higher than those in healthy newborns and their mothers （P 〈 0.05）. The sensitivity of each of maternal t-PA, PAI-1 and t-PA/PAI-1 in later stages of pregnancy in the prediction of HDN was lower than 50%, the accuracy was lower than 60%, and the specificity higher than 70%; the detection sensitivity （56.67%）, specificity （86.96%） and accuracy （75.00%） of the combination of the three indexes were higher than those of single index （P 〈 0.05）. Conclusion The increase of the t-PA, PAI-1 and t-PA/PAI-1 in later stages of pregnancy has certain prompt function in the prediction of HDN. However, the prediction sensitivity of single index or combined detection is low, thus other indexes are still needed to make more accurate judgments.

关 键 词：血浆T-PA PAI-1 预测价值 孕晚期 孕妇 新生儿溶血病 组织纤溶酶原抑制物 组织纤溶酶原激活物 

分 类 号：R714.4[医药卫生—妇产科学]