反复自然流产与抗活化的蛋白C的研究

目的了解抗活化的蛋白C(APCR)在反复自然流产(RSA)患者中的发生情况，并进一步探讨APCR引起胎盘血管微小血栓形成并进而引起RSA的发生机制。方法采用APC-KPTT法，ELISA法和PTT-LA法分别对32例RSA及20例正常对照(NC)进行APCR、抗心磷脂抗体(ACA)和狼疮抗凝物(LA)检测。结果32例RSA患者共17例抗磷脂抗体(APA)阳性，其中9例LA阳性，12例ACA阳性(4例LA、ACA同时阳性)，阳性率(53.1％)明显高于NC组(0/20)(P＜0.005)；其中LA阳性率为28.1％，明显高于NC组(P＜0.01)，患者ACA-IgG(0.32±0.22)、IgM(0.51±0.25)、IgA(0.40±0.27)与NC组无显著性差异(P＞0.05)。患者APCR阳性率为37.5％，明显高于NC组(5.0％)(P＜0.001)，而活性蛋白C敏感比值(APC-SR)低于NC组(P＜0.05)。相关分析显示LA阳性组中的APCR阳性率(66.7％)明显高于LA阴性组(26.1％)(P＜0.05)；而ACA阳性组中的APCR阳性率(25.0％)与ACA阴性组(25.0％)无显著性差异(P＞0.05)。结论APCR在反复自然流产患者中有较高的发生率且与LA有明显相关性，提示APCR可能是引起胎盘微血栓形成并引起反复自然流产的另一重要因素。

Study of recurrent spontaneous abortion and activated protein C-resistance

Objective To understand the occurrence of activated protein C-resistance(APCR)in patients with recurrent spontaneous abortion(RSA)and investigate the occuring mechanism of APCR inducing the mini-thrombosis of placental vessels which results in RSA.Methods APC-KPTT assay,ELISA and PTT-LA methods were used respectively to detect APCR,anticardiolipin antibodies(ACA)and lupus anticoagulant(LA)in 32 patients with RSA and 20 normal controls(NC).Results There were 17 positive of APA(antiphospholipid antibodies)in patients.The incidence(53 1%)was significantly higher than that of NC group(0/20)(P<0 005),the incidence of LA in RSA(28 1%)was higher than that in NC group(0/20)(P<0.01),but there was no significant difference of ACA between the two groups(P>0 05).The incidence of APCR in RSA(37 5%)was significantly higher than that of NC group(5 0%)(P<0 001),but the APC-SR was lower than NC group(P<0 05).Relativity analysis indicated that the incidence of APCR in LA-positive group(66 7%)was obviously higher than that in LA-negative(26 1%)(P<0 05),but there was no significant difference between the ACA-positive and the ACA-negative(P>0 05).Conclusion There is a little bit higher incidence of APCR in patients with RSA and it is related to LA,which suggests that APCR seems to be one of the main reasons to induce the thrombosis in placental vessels which results in RSA.