妊娠高血压疾病患者血栓弹力图、D二聚体及活化蛋白C联合检测的临床意义  

Clinical Significance of Combined Detection of Thromboelastogram,D-dimer and Activated Protein C in Patients with Hypertensive Disorder Complicating

作　　者：何丽梅 朱秀娟 肖春 傅启华[3] 龚波 HE Li-mei;ZHU Xiu-juan;XIAO Chun;FU Qi-hua;GONG Bo(Department of Clinical Laboratory,ShanghaiChangning Maternity and Infant Health Hospital,Shanghai 200050,China;Department of Obstetrics and Gynecology,Shanghai Changning Maternity and Infant Health Hospital,Shanghai 200050,China;Shanghai Children’s Medical Center affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海市长宁区妇幼保健院检验科,上海200050 [2]上海市长宁区妇幼保健院妇产科,上海200050 [3]上海交通大学医学院附属上海儿童医学中心,上海200127

出　　处：《血栓与止血学》2020年第5期725-728,共4页Chinese Journal of Thrombosis and Hemostasis

基　　金：上海市长宁区卫健委(20164Y012)。

摘　　要：目的探讨妊娠高血压疾病(简称妊高征)患者血栓弹力图(TEG)、D二聚体(D-D)及活化蛋白C(APC)联合检测的临床价值。方法入选妊高征患者86例(根据疾病严重程度,妊高征组进一步分为妊娠高血压组30例、轻度子痫前期组26例、重度子痫前期组30例),同时纳入正常妊娠女性(正常妊娠组)255例和正常非妊娠女性(正常对照组)60例,采集样本进行TEG,D-D和APC检测,并进行统计学分析。此外,对86例妊高征患者样本的FV Leiden、FII G20210 A基因进行Sanger测序,利用Chromas序列比对软件对测序结果与正常人群序列进行比对分析,找出多态性位点进行分析。结果与正常对照组、正常妊娠组相比,妊高征组TEG中的凝血反应时间(R值)和血凝块形成时间(K值)以及APC表达水平明显降低(P<0.05),而TEG中最大振幅(MA值)和凝血形成速率(Angle角)以及D-D表达水平均明显增高(P<0.05),且各参数随着病情进展发生相应变化。Angle角与D-D呈正相关,值K与D-D呈负相关,其余参数相关性无统计学意义。FV Leiden和FII G20210 A基因型均未监测到突变位点。结论FV Leiden和FII G20210 A基因突变并非妊娠高血压疾病的遗传性危险因素。TEG、D-D及APC联合检测对于妊娠高血压疾病的及时诊断、治疗和预防有重要的临床意义.Objective To investigate the clinical value of combined detection of thromboelastogram(TEG),D-dimer(D-D)and activated protein C(APC)in patients with hypertensive disorder complicating pregnancy(HDCP).Methods Blood samples were collected from 86 cases of hypertensive disorder complicating pregnancy(HDCP)group,255 cases of normal pregnant women(normal pregnancy group)and 60 cases of normal non pregnant women(normal control group)for detecting thromboelastogram,D-D and APC and those metrics were compared.The patients were divided according to the HDCP levels into Pregnancy hypertension group(n=30),mild preeclampsia group(n=26)and severe preeclampsia group(n=30).In addition,Sanger sequencing of Factor V Leiden and Factor II G20210 A genotype were carried out from 86 HDCP patients and the sequencing results were compared with those of normal population to find out the polymorphic sites for analysis by using chromas sequence comparison software.Results Compared with normal control group and normal pregnancy group,the coagulation reaction time(R)and blood clot formation time(K)values of TEG and the level of activated protein C(PCAT)in HDCP group were significantly reduced(P<0.05),while the maximum amplitude(MA)and coagulation formation rate(Angle angle)values of TEG and the level of D-Dimer(D-D)in HDCP group were significantly increased(P<0.05),and each parameter changed as the progress of the disease.Angle angle and D-D are related positively,while K and D-D are related negatively,and the correlations of other parameters are not statistically significant.No mutations are detected in Factor V Leiden and Factor II G20210 A genotypes.Conclusion Mutations in Factor V Leiden and Factor II G20210 A genes are not genetic risk factors for HDCP.The combined detection of TEG,D-D and APC has important clinical significance for the timely diagnosis,treatment and prevention of pregnancy induced hypertension.

关 键 词：血栓弹力图 D二聚体 妊娠高血压疾病 活化蛋白C 

分 类 号：R445[医药卫生—影像医学与核医学]