孔万仲　王怡　郭跃丽　梁世周　林枝

[摘要] 目的 分析妊娠晚期孕妇狼疮抗凝物（lupus anticoagulant，LA）水平变化，探讨LA检测在妊娠晚期血栓形成性疾病中的临床意义。 方法 选取2015年12月～2016年12月在我院就诊或产前体检的118例妊娠晚期孕妇和120例健康育龄期妇女分别作为观察组和对照组；分别检测两组狼疮抗凝物比值（lupus anticoagulant ratio，LAR）、抗凝血酶Ⅲ（anticoagulant Ⅲ，ATⅢ）、D-二聚体（D dimer，D-D）、凝血酶原时间（prothrombin time，PT）、活化部分凝血活酶时间（activated partial thromboplastin time，APTT）、纤维蛋白原（fibrinogen，FIB）及进行血小板聚集试验（platelet agglutination test，PAgT）。 结果 与对照组比较，观察组的LAR、D-D、FIB和PAgT增高，PT和ATⅢ下降，PT时间缩短，差别有统计学意义（P均<0.05）；以超过对照组平均值为阳性，观察组中的LAR、D-D及PAgT各指标阳性率明显高于FIB阳性率和PT阳性率。 结论 妊娠晚期孕妇LAR的升高与血栓前状态指标的变化相平行。在临床上，LA水平变化与血栓发生发展相关，可监测妊娠晚期血栓形成性疾病的发生。

[关键词] 狼疮抗凝物；妊娠晚期；血栓前状态；血栓形成性疾病

[中图分类号] R446.11；R714.256 [文献标识码] B [文章编号] 1673-9701（2017）12-0144-03

[Abstract] Objective To analyze the changes of lupus anticoagulant（LA） level in pregnant women with late pregnancy， and to explore the clinical significance of LA in detecting thrombotic disease in late pregnancy. Methods 118 cases of women with late pregnancy and 120 healthy women of childbearing age who were admitted or underwent prenatal examination in our hospital from December 2015 to December 2016 were selected as the observation group and the control group，respectively. The lupus anticoagulant ratio（LAR）， anticoagulant Ⅲ（ATⅢ）， D dimer（D-D）， prothrombin time（PT）， activated partial thromboplastin time（APTT） and fibrinogen（FIB） between the two groups were measured and platelet agglutination test（PAgT）was taken. Results Compared with those in the control group，The levels of LAR， D-D， FIB and PAgT were increased， PT and ATⅢ decreased， and PT time was shortened in the observation group， the difference was statistically significant（P<0.05）. It was positive when the mean in the observation group was more over that in the control group. The positive rates of LAR， D-D and PAgT in the observation group were significantly higher than that in FIB and PT. Conclusion The increase of LAR in women with late pregnancy is parallel to that of prethrombotic state. In clinical practice， changes in LA levels are related to the development of thrombosis ，which can monitor the occurrence of thrombotic disease.

[Key words] Lupus anticoagulant； Late pregnancy； Prethrombotic state； Thrombotic disease

妊娠晚期，胎頭入盆压迫髂静脉和产妇的制动等均能造成盆腔和下肢静脉血流缓慢、淤滞，引起生理学、血流动力学和解剖学的改变增加血栓栓塞性疾病发生风险，有报道称其发生风险较非妊娠妇女增加4～5倍[1，2]。另外，若合并有妊高征及静脉曲张等疾病时，会进一步促进血栓形成[3]。

LA是体内的一种抗凝脂抗体（antiphospholipid antibody，APL），大多为IgG或IgM或二者混合型抗体，具有激活血小板、诱导黏附分子和组织因子表达以及激发补体活化，从而诱发形成血栓前状态[4]。LA测定方法包括PTT-狼疮抗凝物测定和罗素蝰蛇毒试验两种检测方式，经研究发现两种方法联合检测可以提供更多的诊断信息，可能在临床上协助临床医生分层预防血栓发生风险[5]。APL被广泛认为是胎儿死亡、严重先兆子痫或严重胎盘机能不全引起的≤34周孕早产以及<10周不明原因流产的风险因素。……