周三琴

(浙江省湖州市长兴县人民医院妇产科，浙江 湖州 313100)



妊娠高血压疾病纤溶及凝血指标的变化及临床意义

周三琴

(浙江省湖州市长兴县人民医院妇产科，浙江 湖州 313100)

目的分析妊娠高血压疾病纤溶及凝血指标的变化及临床意义。方法选取浙江省湖州市长兴县人民医院妇产科自2012年9月至2015年9月收治的253例妊娠期高血压疾病患者，其中轻度子痫前期组患者84例，重度子痫前期组患者89例，妊娠期高血压组患者80例，另选择同时期经体检收治的正常妊娠组孕妇82例，比较两组患者的血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-D二聚体(DD)、组织纤溶酶原激活物(tPA)、纤溶酶原激活抑制物-1(PAI-1)活性。结果妊娠期高血压疾病组较正常妊娠组相比PT、APTT较低，FIB、DD、PAI-1较高，具有显著差异(t值分别为5.65、7.54、7.67、6.38、6.35，均P<0.05)。妊娠期高血压疾病组与正常妊娠组相比tPA无明显差异(t=0.87，P>0.05)。轻度子痫前期组与妊娠期高血压组相比PT、APTT、FIB、tPA均无明显差异(t值分别为0.61、0.73、0.62、0.81，均P>0.05)，轻度子痫前期组较妊娠期高血压组相比DD、PAI-1升高，具有显著差异(t值分别为5.56、5.23，均P<0.05)，重度子痫前期组较轻度子痫前期组相比，PT、APTT显著降低(t值分别为4.26、3.91，均P<0.05)，FIB、DD、PAI-1显著升高(t值分别为5.11、5.56、6.12，均P<0.05)。结论检测妊娠期孕妇的纤溶及凝血指标，对有效预防并治疗妊娠期高血压疾病的发生与发展有重要临床意义。

妊娠高血压；纤溶指标；凝血指标；子痫

[abstract]Objective To analyze the changes and clinical significance of fibrinolytic and blood coagulation indexes in cases of pregnancy-induced hypertension. Methods Totally 253 cases of pregnancy-induced hypertension were selected from People’s Hospital of Changxing County in Zhejiang Province during September 2012 to September 2015, including 84 cases in mild preeclampsia group, 89 cases in severe preeclampsia group, and 80 cases in gestational hypertension group. Another 82 cases of normal pregnancy were selected in control group. Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-D dimer (DD), tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1) activity were compared among groups. Results Compared to normal pregnancy group, gestational hypertension group had lower PT and APTT but higher FIB, DD and PAI-1with significant differences (tvalue was 5.65, 7.54, 7.67, 6.38 and 6.35，respectively, allP<0.05). There was no obvious difference in tPA between gestational hypertension group and normal pregnancy group (t=0.87,P>0.78). PT, APTT, FIB and tPA of mild preeclampsia group were not obviously different from those of gestational hypertension group (tvalue was 0.61, 0.73, 0.62 and 0.81, respectively, allP>0.05), but DD and PAI-1 were higher in mild preeclampsia group with significant differences (tvalue was 5.56 and 5.23, respectively, bothP<0.05). Severe preeclampsia group had relatively lower PT and APTT but higher FIB, DD and PAI-1 than mild preeclampsia group (tvalue was 4.26, 3.91, 5.11, 5.56 and 6.12, respectively, allP<0.05). Conclusion Detecting fibrinolytic and coagulation indexes of pregnant women is of great important for effective prevention and treatment of pregnancy-induced hypertension disease.

[Key words]pregnancy-induced hypertension; fibrinolytic index; coagulation index; pre-eclampsia

妊娠高血压疾病作为一类发生在妇女妊娠期及围产期的常见并发症，严重时可导致孕产妇的死亡。据大量临床研究资料显示，正常机体内的凝血及抗凝血多呈现一动态平衡的状态，而妊娠期妇女的血液则处于生理性高凝状态，目的是为了促进产后止血及快速恢复，但此种状态可因妊娠期妇女体内凝血及抗凝、纤溶及抗纤溶系统发生紊乱，而在一定程度上促进妊娠高血压疾病的发生及发展[1-2]。现对……