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

摘要/Abstract

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。

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

Abstract:

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 pregnancy treated in our hospital between August 2018 and August 2020 were enrolled as the embolization group， while other 73 healthy pregnant 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 diseases during pregnancy were analyzed by multivariate Logistic regression analysis. The diagnostic efficiency of PC， PS， AT-III and combined 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 continuous pregnancy group （46 cases） and the changes of plasma PC， PS and AT-III activities of pregnant women with different pregnancy outcomes 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%， 83.6%） and （89.0%， 74.0%， 86.3%， 90.4%）， respectively. The AUC of combined detection was greater than that of single index （P<0.05）. The of plasma PC， PS and AT-III of the pregnant women in activities in the termination pregnancy group were lower than those in the continuous pregnancy group （P<0.05）. Conclusion： The plasma PC， PS and AT-III activities of patients with thrombotic diseases during pregnancy showed a decreasing trend， and the combined detection can improve diagnostic efficiency of thrombotic diseases during pregnancy.

Key words: Thrombotic diseases during pregnancy； , Protein C； , Protein S； , Antithrombin III； , Clinical significance

中图分类号:

R714.25
R554

李春美, 余莹莹, 陆光辉, 王鑫, 李小兰, 安冬梅.

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 [J]. 中国医药导刊, 2025, 27(2): 177-181.

LI Chunmei, YU Yingying, LU Guanghui, WANG Xin, LI Xiaolan, AN Dongmei.

Changes and Clinical Significance of Plasma Protein C， Protein S and Antithrombin III Activities in Patients with Thrombotic Diseases During Pregnancy [J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2025, 27(2): 177-181.

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