韩宁 陈莹莹 赵娜 赵红阳 胡亚琪 魏团君

【摘要】 目的：評估孕妇血清易栓三项[蛋白C（protein C，PC）、蛋白S（protein S，PS）、抗凝血酶Ⅲ（antithrombin-Ⅲ，AT-Ⅲ）]联合同型半胱氨酸（homocysteine，Hcy）对存在高危因素的孕妇发生胎儿生长受限（fetal growth restriction，FGR）的临床预测价值，为FGR早期诊治提供参考。方法：选择2018年

9月-2020年3月于本院产科进行围产保健的存在FGR高危因素的孕妇120例为研究对象，所有孕妇于孕11～20周抽取静脉血检测PS、PC、AT-Ⅲ活性及Hcy水平，并随访至胎儿娩出，其中3例脱落，39例发生FGR者作为病例组，78例胎儿发育正常者为对照组。比较两组孕11～20周血清PC、PS、AT-Ⅲ及Hcy水平。采用多因素logistic回归分析确定FGR发生的独立危险因素，绘制受试者工作曲线（ROC），记录曲线下面积（AUC），分析PC、PS、AT-Ⅲ及Hcy预测FGR发生的临床价值。结果：病例组Hcy水平高于对照组，PC与AT-Ⅲ活性均低于对照组（P<0.05）。logistic回归分析结果显示，血清Hcy及AT-Ⅲ是FGR发生的独立危险因素（P<0.05）。ROC曲线分析表明，Hcy及AT-Ⅲ单独检测预测FGR的AUC分别为0.761、0.811，联合检测预测FGR的AUC为0.892。结论：血清Hcy及AT-Ⅲ是发生FGR的独立危险因素，两者联合检测对FGR预测价值较高。

【关键词】 胎儿生长受限 蛋白C 抗凝血酶Ⅲ 同型半胱氨酸

Predictive Value of Homocysteine Combined with Three Indicators of Thrombophilia for Fetal Growth Restriction/HAN Ning， CHEN Yingying， ZHAO Na， ZHAO Hongyang， HU Yaqi， WEI Tuanjun. //Medical Innovation of China， 2021， 18（13）： 00-010

[Abstract] Objective： To evaluate the clinical predictive value of maternal serum three indicators of thrombophilia [protein C （PC）， protein S （PS）， antithrombin-Ⅲ （AT-Ⅲ）] combined with homocysteine （Hcy） in the occurrence of fetal growth restriction （FGR） in pregnant women with high risk factors， so as to provide reference for the early diagnosis and treatment of FGR. Method： A total of 120 pregnant women with high risk factors for FGR who received perinatal health care in the obstetrics department of our hospital from September 2018 to March 2020 were selected as the research subjects. All pregnant women were sampled from 11 to 20 weeks of pregnancy to detect the activity of PS， PC， AT-Ⅲ and Hcy level， and followed up until the delivery of the fetus， of which 3 cases fell out， and 39 cases with FGR were taken as the case group. 78 cases of normal fetal development were the control group. The serum levels of PC， PS， AT-Ⅲ and Hcy were compared between the two groups at 11 to 20 weeks of gestation. Multivariate logistic regression analysis was used to determine the independent risk factors for the occurrence of FGR. Receiver operating curve （ROC） was drawn and the area under the curve （AUC） was recorded. The clinical value of PC， PS， AT-Ⅲ and Hcy in predicting the occurrence of FGR was analyzed. Result： The level of Hcy in the case group was higher than that in the control group， and the activities of PC and AT-Ⅲ in the case group were lower than those in the control group （P<0.05）. Logistic regression analysis showed that serum Hcy and AT-Ⅲ were independent risk factors for FGR （P<0.05）. ROC curve analysis showed that the AUC of FGR predicted by Hcy and AT-Ⅲ alone detection was 0.761 and 0.811， respectively， and the AUC of FGR predicted by combined detection was 0.892. Conclusion： Serum Hcy and AT-Ⅲ are independent risk factors for the occurrence of FGR， and their combined detection is of high predictive value for FGR.

[Key words] Fetal growth restriction Protein C Autoprothrombin-Ⅲ Homocysteine

First-authors address： The Third Affiliated Hospital of Zhengzhou University， Zhengzhou 450052， China

doi：10.3969/j.issn.1674-4985.2021.13.002

胎儿生长受限（fetal growth restriction，FGR）指胎儿应有的生长潜力受损，估测的胎儿体重小于同孕龄的第十百分位的小于孕龄儿，是胎儿宫内死亡和脑瘫的独立危险因素，并可能增加胎儿远期患心血管、内分泌等相关疾病的风险[1-3]。近年来，妊娠期血栓前状态与子痫前期、胎盘早剥、FGR和死产的风险之间的关系已成为许多研究的主题[4]。但目前关于Hcy联合AT-Ⅲ预测FGR方面的研究尚未见报道。抗凝血酶缺陷、PC、PS缺乏及血清Hcy浓度高都是妊娠相关易栓症的风险因素[5-9]。本研究旨在探究妊娠早期PC、PS、AT-Ⅲ及Hcy与FGR的相关性并分析其临床预测价值，以提高FGR的检出率，并可以及时给予相关的干预措施，以降低围产儿不良妊娠结局的发生。……