抗凝血酶Ⅲ、蛋白C、蛋白S结合血栓弹力图参数在妊娠晚期孕妇凝血功能状态评估中的应用  

Application of AT-Ⅲ,protein C and protein S combined thromboelastography variables in the assessment of coagulation status of pregnant women in third trimester of pregnancy

作　　者：杜小雨 李辉 贺小红 乔晓亮[1,2] Du Xiaoyu;Li Hui;He Xiaohong;Qiao Xiaoliang(Department of Clinical Laboratory,Zhengzhou Maternal and Child Health Care Hospital,Zhengzhou 450000,China;Key Laboratory of Neonatal Disease Screening and Precision Diagnosis of Henan Provincial Health Commission,Zhengzhou 450000,China;Department of Clinical Laboratory,Zhengzhou Third People’s Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州市妇幼保健院检验科,郑州450000 [2]河南省卫生健康委员会新生儿疾病筛查与精准诊断重点实验室,郑州450000 [3]郑州市第三人民医院检验科,郑州450000

出　　处：《中国实用医刊》2024年第21期73-77,共5页Chinese Journal of Practical Medicine

摘　　要：目的探讨抗凝血酶Ⅲ(AT-Ⅲ)、蛋白C(PC)、蛋白S(PS)三种抗凝蛋白结合血栓弹力图(TEG)参数在妊娠晚期孕妇凝血功能状态评估中的应用价值。方法回顾性抽取2021年6月至2023年6月郑州市妇幼保健院收治的患有静脉血栓栓塞症(VTE)的妊娠晚期孕妇23例(病例组)、同期体检的非孕健康妇女63例(正常对照组)及健康妊娠期妇女196例。按照孕周将196例健康孕妇分为孕晚期组(112例,孕周≥28周)和非孕晚期组(84例,孕周<28周)。所有受试者接受抗凝蛋白活性和TEG检查。比较四组血浆AT-Ⅲ、PC、PS三种抗凝蛋白活性和TEG参数[凝血因子反应时间(R)、凝血形成时间(K)、凝血形成速率(Ang1e)、血凝块最大强度(MA)、凝血综合指数(CI)]。应用受试者工作特征曲线下面积(AUC)分析三种抗凝蛋白活性和TEG参数对妊娠晚期孕妇高凝状态的评估价值。结果病例组(AT-Ⅲ)、PC、PS活性低于孕晚期组及非孕晚期组和正常对照组,孕晚期组AT-Ⅲ、PC、PS活性低于非孕晚期组和正常对照组(P<0.05)。病例组R和K低于孕晚期组、非孕晚期组、正常对照组,Ang1e、MA、CI高于孕晚期组和非孕晚期组及正常对照组(P<0.05);孕晚期组R、K低于非孕晚期组和正常对照组,Ang1e、MA、CI高于非孕晚期组和正常对照组(P<0.05)。AT-Ⅲ、PC、PS活性与R及K呈正相关,与Ang1e、MA、CI呈负相关(P<0.05)。受试者工作曲线结果显示,抗凝蛋白联合及TEG参数联合的AUC为0.803、0.720,灵敏度为80.4%、68.8%,特异度为82.1%、62.5%;TEG参数联合抗凝蛋白的AUC为0.930,灵敏度为92.9%,特异度为93.8%,其灵敏度和特异度高于单一参数检测(P<0.05)。结论妊娠晚期孕妇血液有向高凝发展的趋势且妊娠晚期VTE患者凝血与止血机制发生改变,联合应用血浆AT-Ⅲ、PC、PS三种抗凝蛋白以及TEG参数评估妊娠晚期高凝状态,可以提高评估的特异性和灵敏度,有助于更好地了解妊娠晚期孕妇的ObjectiveTo investigate the role of antithrombinⅢ(AT-Ⅲ),protein C(PC)and protein S(PS)combined thromboelastography(TEG)variables in the assessment of coagulation status of pregnant women in the third trimester of pregnancy.MethodsA retrospective analysis was conducted on 23 pregnant women with venous thromboembolism(VTE)in the third trimester of pregnancy(case group),63 non-pregnant healthy women(normal control group)and 196 healthy pregnant women admitted to Zhengzhou Maternal and Child Health Hospital from June 2021 to June 2023.And the 196 healthy pregnant women were divided into the third trimester group(112 cases,gestational age≥28 weeks)and the non-third trimester group(84 cases,gestational age<28 weeks).All subjects underwent anticoagulant protein activity and TEG tests.The activities of plasma anticoagulant proteins(AT-Ⅲ,PC,PS)and TEG variables,including coagulation factor reaction time(R),coagulation formation time(K),coagulation formation rate(Ang1e),maximum blood clot intensity(MA)and comprehensive coagulation index(CI),were compared among the four groups.The area under the receiver operating characteristic curve(AUC)was used to analyze the value of anticoagulant protein activity(AT-Ⅲ,PC,PS and TEG)and TEG variables in assessing the hypercoagulability status of pregnant women in the third trimester of pregnancy.ResultsThe activities of AT-Ⅲ,PC and PS in the case group were lower than those in the third trimester group,the non-trimester group and the normal control group(P<0.05);the activities of AT-Ⅲ,PC and PS in the third trimester group were lower than those in the non-third trimester group and the normal control group(P<0.05).The R and K of the case group were lower than those of the third trimester group,the non-third trimester group and the normal control group(P<0.05);the Ang1e,MA and CI of the case group were higher than those of the third trimester group,the non-third trimester group and the normal control group(all P<0.05).The R and K levels in the third trimester group were lowe

关 键 词：血栓弹力图 抗凝蛋白 妊娠晚期 凝血功能 

分 类 号：R714.252[医药卫生—妇产科学]