妊娠期血栓性疾病患者血浆PC、PS、AT-Ⅲ活性变化及其临床意义  

Changes and Clinical Significance of Plasma Protein C,Protein S and Antithrombin III Activities in Patients with Thrombotic Diseases During Pregnancy

作　　者：李春美 余莹莹 陆光辉 王鑫 李小兰 安冬梅 LI Chunmei;YU Yingying;LU Guanghui;WANG Xin;LI Xiaolan;AN Dongmei(Minda Hospital Affiliated to Hubei Minzu University,Hubei Enshi 445000,China;Qianjiang Central Hospital,Chongqing Qianjiang 409000,China)

机构地区：[1]湖北民族大学附属民大医院,湖北恩施445000 [2]重庆市黔江中心医院,重庆黔江409000

出　　处：《中国医药导刊》2025年第2期177-181,共5页Chinese Journal of Medicinal Guide

基　　金：湖北省自然科学基金(2019CFB112);重庆市科卫联合医学科研项目(2020FYYX197)。

摘　　要：目的:探讨妊娠期血栓性疾病患者血浆蛋白C(PC)、蛋白S(PS)、抗凝血酶III(AT-III)活性变化及其临床意义。方法:选取2018年8月至2020年8月我院收治的61例妊娠期血栓性疾病孕妇为栓塞组,另选取同期于我院进行孕检的健康孕妇73例为健康组,比较分析栓塞组和健康组孕妇的基本资料。发色底物法检测血浆PC、AT-III活性,凝固法检测血浆PS活性,比较两组孕妇血浆PC、PS和AT-III活性变化。使用多因素Logistic回归分析妊娠期血栓性疾病的危险因素,受试者工作特征曲线(ROC)分析血浆PC、PS和AT-III活性及其联合检测时对妊娠期血栓性疾病的诊断效能。将栓塞组孕妇根据其妊娠结局分为终止妊娠组(15例)和继续妊娠组(46例),比较不同妊娠结局孕妇血浆PC、PS和AT-III活性变化。结果:栓塞组孕妇年龄≥35岁、孕前肥胖(BMI≥30 kg·m^(-2))、血栓性疾病家族史、吸烟、产次、合并高血压构成比例均高于健康组(P<0.05),血浆PC、PS、AT-III活性均低于健康组(P<0.05)。危险因素分析显示年龄≥35岁、孕前肥胖、血栓性疾病家族史、血浆PC(<75.52%)、PS(<53.61%)、AT-III(<84.66%)活性是妊娠期血栓性疾病的危险因素。ROC分析显示,血浆PC、PS、AT-III及其联合检测时的曲线下面积(AUC)分别为0.802、0.773、0.832、0.941,灵敏度分别为59.0%、72.1%、67.2%、83.6%,特异度分别为89.0%、74.0%、86.3%、90.4%,联合检测时的AUC高于血浆PC、PS、AT-III单独检测(P<0.05)。终止妊娠组孕妇的血浆PC、PS、AT-III活性均低于继续妊娠组(P<0.05)。结论:妊娠期血栓性疾病患者血浆PC、PS、AT-III活性呈降低趋势,其联合检测可以提高妊娠期血栓性疾病诊断效能。Objective:To explore the changes and clinical significance of plasma protein C(PC),protein S(PS)and antithrombin III(AT-III)activities in patients with thrombotic diseases during pregnancy.Methods:61 patients with thrombotic diseases during preg-nancy treated in our hospital between August 2018 and August 2020 were enrolled as the embolization group,while other 73 healthy preg-nant women during the same period were enrolled as the healthy group.The basic data of the two groups were compared.The plasma PC and AT-III activities were detected by developing substrate method.The activity of plasma PS was detected by freezing method.The changes of plasma PC,PS and AT-III activities of the two groups of pregnant women were compared.The risk factors of thrombotic dis-eases during pregnancy were analyzed by multivariate Logistic regression analysis.The diagnostic efficiency of PC,PS,AT-III and com-bined detection for thrombotic diseases during pregnancy was analyzed by receiver operating characteristic(ROC)curves.According to pregnancy outcomes,pregnant women in the embolization group were divided into termination pregnancy group(15 cases)and continu-ous pregnancy group(46 cases)and the changes of plasma PC,PS and AT-III activities of pregnant women with different pregnancy out-comes were compared.Results:The proportions of cases with age≥35 years,progestational obesity(BMI≥30 kg·m^(-2)),family history of thrombotic diseases,smoking,parity and hypertension in the embolization group were higher than those in the healthy group(P<0.05),while plasma PC,PS and AT-III activities were lower than those in the healthy group(P<0.05).Analysis of risk factors showed that age≥35 years,progestational obesity,family history of thrombotic diseases,plasma PC(<75.52%),PS(<53.61%),AT-III(<84.66%)activities were risk factors of thrombotic diseases during pregnancy.ROC analysis showed that the area under curve(AUC),sensitivity and specificity of plasma PC,PS,AT-III and combined detection were(0.802,0.773,0.832,0.941),(59.0%,72.1%,67.2%

关 键 词：妊娠期血栓性疾病 蛋白C 蛋白S 抗凝血酶III 临床意义 

分 类 号：R714.25[医药卫生—妇产科学] R554[医药卫生—临床医学]