早发型重度子痫前期母血中抗磷脂抗体及血栓前状态变化的研究

目的：研究重度子痫前期患者母血的抗磷脂抗体及血栓前状态等标志物变化，寻找敏感、有效的指标预测早发型重度子痫前期的发生。方法收集需住院分娩的重度子痫前期的孕妇共70例，早发型重度子痫前期患者32例；晚发型重度子痫前期患者38例。同时随机选取30例同期入院的正常孕妇为对照组。所有的孕妇均为单胎妊娠，排除慢性高血压及慢性肾病。住院时检测：血常规、血脂、肾功能、肝功能、糖耐量、24 h尿蛋白定量；凝血四项、栓溶二聚体（D-Dimer）、抗凝血酶Ⅲ（AT-Ⅲ）等血栓前状态分子标志物；抗心磷脂抗体（ACA）-IgM、IgG及抗β2-GPI抗体定量等生化指标。结果早发型重度子痫前期抗磷脂抗体阳性率及ACA-IgM的滴度值明显高于晚发型重度子痫前期及正常对照组，差异有统计学意义（P＜0.05），晚发型重度子痫前期抗磷脂抗体阳性率高于正常对照组，差异无统计学意义（P＞0.05）；早发型和晚发型重度子痫前期的血栓前状态比正常妊娠组更为严重，差异有统计学意义（P＜0.05），但早发型和晚发型重度子痫前期的血栓前状态比较差异无统计性意义（P＞0.05）；抗磷脂抗体定量与血栓前状态的严重程度不存在明显相关性。结论对有高危因素的孕妇可通过检测血栓前状态的变化预测重度子痫前期的发病，进一步可通过抗磷脂抗体阳性率及ACA-IgM的滴度值鉴别早发型和晚发型重度子痫前期。

The change research of the antiphospholipid antibodies and prothrombotic state in the early-onset severepreeclampsia maternal blood

Objective To study maternal antiphospholipid antibodies and other markers of prothrombotic state changes in patients with severe preeclampsia, looking for sensitive, effective indicators to predict early onset severe preeclampsia. Methods Seventy cases of pregnant women with severe preeclampsia were investigated, including 32 cases of early-onset severe preeclampsia and 38 cases of late-onset severe preeclampsia. 30 cases of normal pregnant women were randomly selected as the normal control group. All pregnant women were singleton pregnancies, excluding chronic hypertension and chronic kidney disease. ALL pregnant women had blood routine examination, blood lipid, renal function, liver function, glucose tolerance, and four items of blood coagulation, including thrombosis dissolved two mer （D-Dimer）, antithrombin Ⅲ（AT-Ⅲ）, 24 hour urinary protein quantitative anticardiolipin antibodies （ACA）-IgM, IgG, and anti-β2 GPI antibody and etc. index. Results Positive rate of antiphospholipid antibody and ACA-IgM titer in early onset severe preeclampsia was significantly higher than late-onset severe preeclampsia and normal control group, the difference was statistically significant （P〈0.05）, Positive rate of antiphospholipid antibody in Late-onset severe preeclampsia was higher than the normal control group, the difference was not statistically significant （P〉0.05）; Prothrombotic state in cases of early-onset and late-onset severe preeclampsia patients were more severe than normal pregnancy group, the difference was statistically significant （P〈0.05）, but prothrombotic state showed no difference between early-onset and late-onset severe preeclampsia, the difference had no statistical significance （P〉0.05）;Between antiphospholipid antibodies quantitative and severity of prothrombotic state had no significant correlation. Conclusion Detection of prothrombotic state changes in pregnant women with risk factors help to predict severe preeclampsia, and further by antiphospholipid antibodies positive rate and ACA-IgM titer values we can identify early-onset and late-onset severe preeclampsia.