长沙健康妊娠妇女新凝血标志物水平变化及其参考区间的建立  

Changes of new coagulation markers in healthy pregnant women and establishment of reference intervals in Changsha

作　　者：杨燕贻[1] 胡芸[2] 武明阳 项忠元[4] YANG Yanyi;HU Yun;WU Mingyang;XIANG Zhongyuan(Heath Management Center,Second Xiangya Hospital,Central South University,Changsha 410011;Department of Obstetrics and Gynecology,Second Xiangya Hospital,Central South University,Changsha 410011;Xiangya School of Medicine,Central South University,Changsha 410013;Department of Laboratory Medicine,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院健康管理中心,长沙410011 [2]中南大学湘雅二医院妇产科,长沙410011 [3]中南大学湘雅医学院,长沙410013 [4]中南大学湘雅二医院检验科,长沙410011

出　　处：《中南大学学报（医学版）》2022年第4期469-478,共10页Journal of Central South University ：Medical Science

基　　金：supported by the Natural Science Foundation of Hunan Province,China(2018JJ3770)。

摘　　要：目的:妊娠妇女的血液处于高凝状态,易发生凝血和纤溶系统的障碍。本研究旨在探讨目前最新的凝血标志物凝血酶-抗凝血酶复合物(thrombin-antithrombin complex,TAT)、纤溶酶-α2纤溶酶抑制物的复合物(plasmin-α2plasmin inhibitor complex,PIC)、组织型纤溶酶原激活剂/组织型纤溶酶原抑制剂复合物(tissue plasminogen activator/plasminogen activator inhibitor compound,tPAI-C)和血栓调节蛋白(thrombomodulin,TM)在不同妊娠时期的水平变化,并建立其参考区间,为临床医师提供有效、可靠的参考。方法:收集2019年10月至2020年10月在中南大学湘雅二医院产科进行孕期检查和生产的492例健康妊娠妇女,将其分为早孕组、中孕组、晚孕组和产褥组,并选取123例健康非妊娠妇女作为对照组。利用化学发光法测定TAT、PIC、tPAI-C和TM的水平。分析非妊娠妇女、妊娠妇女、产褥期妇女各标志物水平的差异,并建立相应的参考区间。结果:TM、TAT在早孕、中孕及晚孕组逐渐升高,在产褥组逐渐降低(P<0.05或P<0.01)。健康非妊娠妇女的PIC水平低于妊娠妇女(P<0.05或P<0.01),而妊娠和产褥期妇女的PIC水平差异无统计学意义(P>0.05)。健康非妊娠妇女tPAI-C水平低于妊娠妇女(P<0.05或P<0.01),产褥期妇女t PAIC水平显著降低(P<0.01)。TM的参考区间:健康非妊娠妇女为3.20~4.60 TU/mL,早孕期和中孕期为3.12~7.90 TU/mL,晚孕期为3.42~8.29 TU/mL,产褥期为2.70~6.40 TU/mL。TAT的参考区间:健康非妊娠妇女为0.50~1.64 ng/mL,早孕期和中孕期为0.52~6.91 ng/mL,晚孕期为0.96~12.92 ng/mL,产褥期为0.82~3.75 ng/mL。PIC的参考区间:健康非妊娠妇女为0.160~0.519 ng/mL,妊娠妇女为0.162~0.770μg/mL。tPAI-C的参考区间:健康非妊娠妇女为1.90~4.80 ng/mL,早孕期和中孕期为2.03~9.33 ng/mL,晚孕期为2.80~14.20 ng/mL,产褥期为1.10~8.40 ng/mL。结论:妊娠妇女的4项新凝血标志物TM、TAT、PIC及tPAI-C的水平随孕期的发展显�Objective:There is a high coagulation state in pregnant women,which is prone to coagulation and fibrinolysis system dysfunction.This study aims to explore the latest coagulation markers—thrombomodulin(TM),thrombin-antithrombin complex(TAT),plasmin-α2 plasmin inhibitor complex(PIC),and tissue plasminogen activator/plasminogen activator inhibitor compound(tPAI-C)in different stages of pregnancy,establish reference intervals(RIs)for healthy pregnant women of Chinese population,and to provide an effective and reliable reference for clinicians.Methods:A total of 492 healthy pregnant women,who underwent pregnancy examination and delivery in the Department of Obstetrics,Second Xiangya Hospital of Central South University from October 2019 to October 2020,were enrolled for this study.They were assigned into the first trimester group,the second trimester group,the third trimester group,and the puerperium group according to the pregnancy period,and 123 healthy non-pregnant women were selected as the controls.Plasma levels of TM,TAT,PIC and tPAI-C were analyzed by automatic chemiluminescence immunoassay analyzer.The RIs for TM,TAT,PIC,and tPAI-C were defined using non-parametric 95%intervals,determined following Clinical and Laboratory Standards Institute Document C28-A3c(CLSI C28-A3c),and Formulation of Reference Intervals for the Clinical Laboratory Test Items(WS/T402-2012).Results:TM and TAT levels increased gradually in the first,second,and third trimester women and decreased in the puerperium women(P<0.05 or P<0.01).PIC level of healthy non-pregnant women was lower than that of pregnant women(P<0.05 or P<0.01),but PIC level of pregnant and puerperium women did not differ significantly(P>0.05).tPAI-C level in healthy non-pregnant women was lower than that of pregnant women(P<0.05 or P<0.01),and tPAI-C level was significantly decreases in the puerperium women(P<0.01).The RIs for TM were as follows:Healthy non-pregnant women at 3.20-4.60 TU/mL,the first and second trimester at 3.12-7.90 TU/mL,the third trimester at 3.4

关 键 词：妊娠 血栓调节蛋白 凝血酶-抗凝血酶复合物 纤溶酶-α2纤溶酶抑制物的复合物 组织型纤溶酶原激活剂/组织型纤溶酶原抑制剂复合物 参考区间 

分 类 号：R714[医药卫生—妇产科学]