抗凝蛋白缺陷与反复妊娠丢失相关性研究  

A Study on the Deficiency of Anticoagulant Proteins and Recurrent Pregnancy Loss

作　　者：钟兰萍[1,2] 马蕊 康晓敏[1,2] 

机构地区：[1]云南省第一人民医院,云南 昆明 [2]昆明理工大学附属医院生殖医学科,云南 昆明

出　　处：《临床医学进展》2022年第4期3710-3716,共7页Advances in Clinical Medicine

摘　　要：目的:探讨中国反复妊娠丢失(Recurrent Pregnancy Loss, RPL)患者血浆抗凝蛋白缺陷的特征。方法:收集2019年~2021年期间在我院门诊就诊的1604例患者进行回顾性病例对照研究,其中RPL患者1407例,非RPL患者200例。抗凝蛋白指标包括:蛋白S、蛋白C、抗凝血酶III (Antithrombin III, AT-III)。使用SPSS17.0软件进行统计学分析(SPSS Inc, ChicagoIL, USA)。结果:在1407例RPL患者中,蛋白S缺陷最为常见,占21.32%,AT-III缺陷发生率为1%,蛋白C活性低下比例为0.64%。在200例非RPL患者中,仅10%的患者出现蛋白S活性降低,蛋白C和AT-III活性均正常。蛋白S活性低下在RPL组和非RPL组之间有统计学差异(P 0.05)。且随着流产次数的增加,蛋白S活性低下的发生率显著增加(P 【0.01, P 【0.001)。有晚期流产史(妊娠≥12)的RPL患者蛋白S活性低下发生率明显高于有早期流产史(妊娠【12 w) (22.81% vs 16.88%, P 【0.05)的RPL患者。另外,约25%合并自身抗体阳性的RPL患者中出现蛋白S活性低下(P 【0.05),继发性APS患者中蛋白S活性异常的发生率高达50% (P 【0.001)。结论:中国RPL患者发生血浆蛋白S缺陷的比例增高,尤其有晚期流产史和自身抗体呈阳性的RPL患者蛋白S缺陷发生比例更高。建议对有晚期流产史和自身抗体阳性的RPL患者进行蛋白S的检测和及早的治疗。Aim: To investigate the characteristics of plasma anticoagulant protein deficiency in Chinese patients with recurrent pregnancy loss (RPL). Methods: A retrospective and case-control study was conducted of 1407 RPL patients and 200 women without a history of RPL in our Outpatient Clinic during 2019 to 2021 by the following factors: Protein S, protein C, antithrombin III (AT-III). The data were analyzed using SPSS 17.0 software (SPSS Inc, Chicago, IL, USA). Results: Of 1407 RPL patients, low protein S activity was the most prevalent (21.32%). ATIII was abnormal in 1% and Protein C was abnormal in 0.64%. 10% non-RPL patients were subjected to reduced activity of Protein S, whereas Protein C and AT-III were normal in all non-RPL cases. Protein S activity was significantly lower in RPL group than in non-RPL Group (P 0.05). With increasing abortions, the incidence of low protein S activity increased significantly (P 0.05). The incidence of low protein S activity was significantly higher in RPL patients with late abortion (≥12 weeks of gestation) than those with early abortion (<12 w) (22.81% vs 16.88%, P <0.05). Approximately 25% of RPL individuals who are positive antibodies have reduced activities of protein S (P <0.05). Moreover, the prevalence of low protein S activity goes up to 50% in RPL patients with APS and positive other antibodies (P <0.001). Conclusion: Reduced Protein S activity occurs in Chinese women with RPL, especially for those with late abortion and positive for auto-antibodies. We suggest performing the tests of Protein S tests in RPL patients with a history of late abortion and positive auto-antibodies in order to find an early treatment for these disorders.

关 键 词：蛋白S 蛋白C 抗凝血酶III 自身抗体 反复妊娠丢失 

分 类 号：R714.2[医药卫生—妇产科学]