早期妊娠妇女凝血、抗凝、纤溶与抗纤溶指标的测定

目的了解早期妊娠凝血、抗凝、血栓形成、纤溶和抗纤溶状态的改变。方法选取105例妊娠10～12周孕妇为研究组,另选取82例正常未孕者为对照组。测定凝血状态指标,包括凝血常规即血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（Fg）以及凝血酶原片段1＋2（F1＋2）、凝血酶-抗凝血酶复合物（TAT）,同时测定抗凝、纤溶与抗纤溶分子标志物,包括抗凝血酶-Ⅲ（AT-Ⅲ）、血小板颗粒糖蛋白140（GMPl40）、血栓烷B2（TXB2）、D二聚体（D—Ⅱ）、纤溶酶原激活物抑制物（PAI-2）。结果研究组Fg、F1＋2、TAT、D—Ⅱ、PAI．2分别为4．00、179．95、0．66、201．51、46．80,明显高于对照组的2．52、39．46、0．31、125．02、5．87,差异有统计学意义（P〈0．008）,而研究组反映血栓形成的指标GMP140为9．42,显著低于对照组的19．13,差异有统计学意义（P〈0．008）。结论正常妊娠早期,血液凝血功能增强,抗凝状况无明显改变,纤溶活性及抗纤溶活性出现亢进,血栓形成减少,这样的改变可能有利于保持充足的胎盘子宫血流灌注量。     

Coagulation and fibrinolysis in the dog.

A range of tests of coagulation and fibrinolysis was measured in "normal" dogs and compared with values obtained in "normal" humans by the same methods. The hematocrit platelet count, fibrinogen and plasminogen were similar in dogs and in humans. The prothrombin and partial thromboplastin times were considerably shorter in the dog than in man but the thrombin clotting time was comparable. Fibrinolysis was more active in dogs but the levels of fibrin degradation products were low, suggesting that there was no significant fibrin deposition and lysis occurring in vivo.     

Blood pressure during pregnancy in Canadian Inuit: community differences related to diet.

OBJECTIVE: To assess a possible relation between the incidence of hypertension during pregnancy and the consumption of fatty acids found in fish and sea mammals. DESIGN: Retrospective survey of pregnancy-induced hypertension; prospective diet survey. SETTING: Inuit women from seven communities in the Keewatin region of the Northwest Territories. PATIENTS: All women from Arviat (formerly Eskimo Point), Baker Lake, Chesterfield Inlet, Coral Harbour, Repulse Bay, Sanikiluaq and Whale Cove who gave birth between Sept. 1, 1984, and Aug. 31, 1987. MAIN OUTCOME MEASURES: All blood pressure measurements recorded during the pregnancy, incidence of pregnancy-induced hypertension in the seven communities, harvest of country food (food obtained from the land or sea rather than bought in a store) for six of the communities, self-reported consumption of fish, sea mammals and terrestrial mammals by a subgroup of the subjects and levels of phospholipid fatty acids in cord serum samples from a subgroup of the infants. MAIN RESULTS: Significantly lower mean diastolic blood pressure values during the last 6 hours of pregnancy were noted for the women from the three communities with a higher consumption of fish and sea mammals (78.2 [95% confidence limits (CL) 76.6 and 79.9] mm Hg) than for those from the four communities with a lower consumption of such food (81.5 [95% CL 80.1 and 82.9] mm Hg) (p less than 0.005). The relation between community diet type and blood pressure was independent of other factors. Correspondingly, the women from communities with a lower consumption of marine food were 2.6 times more likely to be hypertensive during the pregnancy than those from communities with a higher consumption of marine food (p less than 0.007). Parity (p less than 0.05) and prepregnancy weight (p less than 0.005) were also significantly associated with pregnancy-induced hypertension; however, the relation between hypertension and community diet type remained significant in logistic regression analysis (odds ratio 2.56, p = 0.03). The differences between the community groups were substantiated by the results of the diet survey, the levels of eicosapentaenoic acid (EPA) in the cord serum phospholipids and the harvest data. CONCLUSIONS: Increased consumption of fish may be beneficial for women at risk for hypertension during pregnancy. A prospective randomized trial of fish or EPA supplementation during pregnancy is warranted.     

妊娠高血压综合征患者凝血四项和D-二聚体检测分析

目的探讨妊娠高血压综合征（简称妊高征）患者的血凝与纤溶指标变化,为临床防治妊高征提供理论依据。方法采用法国STAGO全自动血凝分析仪测定,对妊高征患者（妊高征组）45例、正常妊娠组50例及同期健康体检女性50例（对照组）的凝血酶原时间（PT）、活化部分凝血活酶时间（AgTT）、凝血酶时间（TT）、纤维蛋白原（Fbg）及D-二聚体（DD）进行检测分析。结果正常妊娠组与对照组相比,正常妊娠组的门和APTT下降,而Fbg和DD升高（P〈0．05）;妊高征组与正常妊娠组相比,妊高征组的PT和AP订进一步下降,Fbg和DD进一步升高（P〈0．05）。TT差异无统计学意义（P〉0．05）。结论妊高征患者存在高凝状态及纤溶亢进,产前测定凝血功能及DD指标,对妊高征的预防及指导临床治疗具有重要意义。     

妊娠贫血患者不同孕期血常规及凝血功能变化研究

目的:研究妊娠期贫血患者在不同孕期的血常规和凝血功能变化。方法:选取产检并分娩的孕妇198例,其中孕早期22例,孕中期80例,孕晚期96例。对不同孕期患者的贫血类型进行分析,贫血类型包括小细胞贫血、大细胞贫血和其他贫血。对妊娠贫血患者不同孕期的血常规变化进行分析。对贫血患者不同孕期不同程度(轻度、中度和重度)贫血发生率进行分析。对妊娠贫血患者不同孕期的凝血功能变化进行分析。结果:不同孕期小细胞贫血、大细胞贫血的发生率存在统计学差异(P<0.05),其他类型贫血的发生率比较,差异无统计学意义(P>0.05)。不同孕期贫血类型比较,差异有统计学意义(P<0.05),孕早期和孕中期主要以小细胞贫血为主,孕晚期以大细胞贫血为主。不同孕期贫血患者红细胞比容(HCT)、血红蛋白(Hb)、外周血红细胞(RBC)、平均红细胞体积(MCV)、平均红细胞血红蛋白含量(MCH)和平均红细胞血红蛋白浓度(MCHC)比较,差异有统计学意义(P<0.05),其中孕中期贫血患者的HCT、Hb、RBC和MCHC水平显著低于孕早期(P<0.05),孕晚期贫血患者的HCT、Hb、RBC、和MCHC均显著低于孕早期和孕中期(P<0.05)。不同孕期贫血患者轻度贫血和中度贫血的发生率比较,差异有统计学意义(P<0.05),孕早期均为轻度贫血,孕中期和孕晚期轻度贫血发生率均呈下降趋势。不同孕期的贫血发生率比较,差异有统计学意义(P<0.05)。不同孕期贫血患者的活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)水平比较,差异有统计学意义(P<0.05)。孕中期贫血患者APTT、TT水平显著低于孕早期(P<0.05)。孕晚期贫血患者的APTT、PT和TT显著低于孕早期和孕中期(P<0.05),纤维蛋白原(FIB)显著高于孕早期和孕中期(P<0.05)。结论:针对妊娠贫血患者,应进行血常规及凝血功能的连续检测,以有利于调整营养方案,防止贫血及其他妊娠期并发症的发生或加重,进而减少不良妊娠结局的发生。     

Epidemic hemorrhagic fever. The mechanism of coagulation and fibrinolysis.

To understand the mechanism of hemorrhage, coagulation and fibrinolysis in epidemic hemorrhagic fever (EHF), thrombin time (TT), prothrombin time (PT), fibrinogen (FIG), the platelet count (PLAT), plasminogen (PLG), antithrombin-III (AT-III), fibrin-fibrinogen degraded products (FDP) and platelet functions of aggregation and release were studied dynamically with advanced methods in 134 EHF patients. TT and PT were prolonged, FIG, AT-III and PLG were decreased and FDP was increased. Besides, the decrease of PLAT, the platelet functions of aggregation and release were below the normal level. The results showed that the balance of blood coagulation and fibrinolysis was lost from the early stage of the disease.

     

Drugs in pregnancy and lactation.

The hazards of exposing the human fetus to drugs have become increasingly apparent in the last 15 years, during which time drug usage has steadily increased. Even though a direct cause-and-effect relationship between certain commonly used drugs and fetal disorders or malformations has been difficult to establish, the principle of avoidance of all but essential medications in pregnancy and in the potentially pregnant has become increasingly important. This paper summarizes the factors determining fetal damage and lists the problems associated with some drugs frequently encountered in practice.