胎儿生长受限与孕妇抗凝血酶Ⅲ、蛋白C、D 二聚体相关性及抗凝治疗效果  

Correlation between the level of antithrombin Ⅲ, protein C, or D-dimer and fetal growth restriction, and the clinical effect of anticoagulant therapy

作　　者：李春英 陈少慧 李海静 冯书梅 陈苑红 LI Chunying;CHEN Shaohui;LI Haijing;FENG Shumei;CHEN Yuanhong(Dongguan East Central Hospital(Dongguan Changping Hospital,Affiliated to Jinan University),Guangdong Province,523573)

机构地区：[1]广东省东莞市东部中心医院(暨南大学附属东莞常平医院),523573

出　　处：《中国计划生育学杂志》2020年第9期1420-1424,共5页Chinese Journal of Family Planning

基　　金：广东省东莞市社会科技发展(一般)项目(201950715035334)。

摘　　要：目的:探讨抗凝血酶Ⅲ(ATⅢ)、蛋白C(PC)、D二聚体与胎儿生长受限的相关性,探讨抗凝治疗效果。方法:选择本院胎儿生长受限(FGR)孕妇120例(FGR组)和120例正常孕妇(对照组),检测血浆ATⅢ、PC、D二聚体水平,分析组间差异以及ATⅢ、PC、D二聚体与FGR相关性。FGR患者分为治疗组(60例)采用低分子肝素抗凝治疗,常规组(60例)接受基础治疗。观察两组治疗前后血浆ATⅢ、PC、D二聚体、脐血流阻力指数(RI)、搏动指数(PI)、脐动脉血流阻抗峰速比值(S/D)水平,以及宫高、头围、腹围、双顶径、股骨长增长情况和妊娠结局。结果:FGR组血浆ATⅢ、PC水平低于对照组,D二聚体高于对照组(均P<0.05)。Spearman相关分析,ATⅢ、PC与FGR呈负相关(r=0.421、0.502,P<0.05),D二聚体水平与FGR呈正相关(r=0.473,P<0.05)。FGR患者治疗后治疗组ATⅢ、PC水平,宫高、头围、腹围、双顶径、股骨长增长高于常规组,D二聚体,脐血流RI、PI、S/D水平低于常规组,新生儿出生体重高于常规组,新生儿早产率、剖宫产率低于常规组(均P<0.05)。结论:FGR患者ATⅢ、PC水平降低,D二聚体水平升高,ATⅢ、PC、D二聚体可能参与了FGR的发病过程。低分子肝素抗凝治疗可显著降低患者D二聚体水平,提高ATⅢ、PC活性,促进胎儿生长发育,改善脐血动力学和妊娠结局。Objective: To explore the correlation between the level of antithrombin Ⅲ(AT-Ⅲ), protein C(PC), or D-dimer and fetal growth restriction(FGR), and to explore the clinical efficacy of anticoagulant therapy. Methods: 120 pregnant women with FGR were selected in study group, and 120 normal pregnant women were selected in control group. The plasma AT-Ⅲ, PC, and D-mer levels of women in the two groups were detected, and which’s differences were analyzed between the two groups. The correlation between the level of AT-Ⅲ, PC, or D-mer and FGR were also analyzed. The women in the study group were divided into group A and B by random number table method. 60 women in group A were treated with low molecular weight heparin anticoagulation, and 60 women in group B had received basic treatment only. The levels of plasma AT-Ⅲ, PC, D-mer, and drag index(RI), pulsatility index(PI), and S/D value of umbilical artery flow, and the values of uterine height, head circumference, abdominal circumference, biparietal diameter, femur growth, and pregnancy outcomes of women in group A and B were observed before and after treatment. Results: The levels of plasma AT-Ⅲ and PC of women in the study group were significant lower than those of women in the control group(P<0.05). Spearman correlation analysis showed that the levels of plasma AT-Ⅲ and PC were negatively correlated with FGR(F=-0.421,-0.502, P<0.05), but D-dimer level was positively correlated with FGR(r=0.473, P<0.05). The levels of AT-Ⅲ and PC, and the values of uterine height, head circumference, abdominal circumference, biparietal diameter, and femur long growth, and neonatal birth weight in group A were significant higher than those in group B(P<0.05),but the D-dimer level,and the values of RI,PI,and S/D of umbilical blood flow,and the rates of preterm birth and cesarean section in group A were significant lower than those in group B(P<0.05).Conclusion:The AT-Ⅲ and PC levels of women with FGR decrease,but their D-dimer level increase,which all may be involved i

关 键 词：胎儿生长受限 抗凝血酶Ⅲ 蛋白C D二聚体 低分子肝素 抗凝治疗 

分 类 号：R714.5[医药卫生—妇产科学]