妊娠期高血压病患者血栓标志物及血小板活化状态研究

目的 检测妊娠期高血压病患者血栓标志物D-二聚体（D—D）、血管性血友病因子vWF，抗凝血酶活性（AT：A）、纤溶酶原活性（PLG：A）水平及血小板活化状态标志物血小板α颗粒膜糖蛋白（CD62P）及溶酶体膜糖蛋白（CD63）的表达，探讨其与妊娠期高血压病发生发展的关系。方法采用免疫比浊法、发色底物法和流式细胞术分别测定66例妊娠期高血压病患者（其中妊娠期高血压20例，轻度子痫前期24例，重度子痫前期和子痫22例）和24例正常晚期孕妇（正常晚孕组）及30例正常非孕妇女（正常非孕组）外周血中的D—D、vWF、AT：A、PLG：A水平和CD62P及CD63的表达。结果正常晚孕组D-D、CD62P和CD63的表达均明显高于正常非孕组（P〈0．05及0．01），vWF、AT：A和PLG：A表达水平差异无统计学意义（P〉0．05）。妊娠期高血压病组D—D水平和CD62P、CD63的表达均明显高于正常晚孕组（P〈0．05及0．01），AT：A水平明显低于正常晚孕组（P〈0．05），妊娠期高血压病患者PLG：A与vWF水平与正常晚孕组比较，差异无统计学意义（P〉0．05）；轻度子痫前期患者与重度子痫前期和子痫患者各标志物分别与正常晚孕组和妊娠期高血压病组比较，差异有统计学意义和非常显著性意义（P〈0．05及0．61）。相关分析D—D水平与vWF水平无相关性（P〉0．05），而CD62P、CD63之间呈正相关（r=0．767，P〈0．01）．结论妊娠期高血压病患者均存在血管内皮细胞损伤，血小板明显活化，血液呈高凝和血栓前或血栓状态。D—D、vWF、AT：A、PLG：A、CD62P、CD63水平在一定程度上可反映妊娠期高血压病患者病情程度，检测其水平对其诊断、观察病情及防止血栓及子痫的发生均有意义。

Study on the Makers of Thrombus and Platelet Activation in Patients of Hypertensive Disorder Complicating Pregnacy

Objective To explore the relationship between the changes levels of makers of thrombosis （ D- D, vWF, AT ： A, PLG ： A） and platelet membrance glycoprotein （ CD 62P, CD 63 ） in patients of hypertensive disorder complicating pregnacy（HDCP）. Methods The level of platelet membrance glyeoprotein （ CD 62P, CD 63） were determined by flow cytometry （FCW） ,D-D and vWF were determined by immunol nephelometry, AT ： A, PLG ： A determined by chromogenic substrate analysis, 66 cases of patients and 24 cases of normal late pregnancy women, 30 cases of non- pergnacy women were determined. Results The levels of D-D , CD62P, CD63 in the plasma of normal late pregnancy women were significantly higher than that in non-pergnacy women （ P 〈 0.05 and 〈 0.01 ） , but the levels of vWF, AT ： A and PLG ： A were no difference between that in non-pergnacy women （P 〉0.05）. The levels of D-D ,CD 62P,CD 63 in the plasma of gestational hypertension patients were significantly higher than that in normal late pregnancy women （ P 〈 0.05 and 〈 0. 01 ）, but the levels of AT：A was significantly lower than that in normal late pregnancy women （P 〈 0.05 ）, the levels of vWF and PLG：A in gestational hypertension patients were no difference between that in normal late pregnancy women （P 〉 0.05 ）. The levels of all makers in the patients were higher or lower than that in light preeclampsia patients and severe pre- eclampsia and eclampsia patient patients （ P 〈 0.05and0.01 ）. The levels of D-D was no correlated with vWF,P 〈0.05） , the levels of CD 62P was correlated with CD 63（r = 0. 767, P 〈 0.01 ）. Conclusion HDCP patients usually exist vascular endothelial injury , platelet activation and hypercoagulability and prethrombotic state or thrombotic state , The plasma level of D- D, vWF, AT： A, PLG ： A, CD 62P and CD 63 may reflect changes in HDCP patients to a certain extent , the research confirmed that the detection of the markers was useful for diagnosis and monitoring the clinical course to HDCP patients avoiding thrombus and eclampsia occurrence.