蛋白Z和蛋白Z依赖的蛋白酶抑制物在正常妊娠妇女中的变化和意义

目的探讨不同孕期正常妊娠妇女血浆蛋白Z(PZ)、蛋白Z依赖的蛋白酶抑制物(ZPI)浓度及其临床意义。方法选择正常未孕妇女、妊娠早期(14～27周)、妊娠晚期(28～40周)各50例,用酶联免疫吸附试验(ELISA)竞争法测定其血浆PZ和ZPI浓度,用凝固法检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)和纤维蛋白原(Fg)浓度。结果 PZ和ZPI从正常未孕妇女至妊娠早期、妊娠晚期,其血浆浓度逐渐下降,妊娠后期比正常未孕妇女PZ下降16.1%,ZPI下降22.8%。妊娠早期、妊娠后期与正常未孕妇女比较,PT、TT明显缩短(P<0.01),Fg明显增高(P<0.01);妊娠晚期与妊娠早期比较PT和TT明显缩短(P<0.05),Fg明显增高(P<0.05);妊娠后期组APTT与正常未孕妇女比较明显缩短(P<0.05)。PZ、ZPI浓度降低与PT异常有一定相关性。结论随着妊娠周数增加,孕妇凝血因子活性和凝血功能增强,可能与抗凝物质PZ、ZPI血浆浓度逐渐下降有关,这种妊娠期生理变化为产后快速有效止血提供了物质基础,但也可能使妊娠期血栓形成的风险增大。

The change and significance of protein Z and protein Z-dependent protease inhibitor in healthy pregnant women

Objective To investigate the levels and clinical significance of plasma protein Z（PZ） and protein Z-dependent protease inhibitor（ZPI） during different gestational periods in healthy pregnant women.Methods Fifty cases of healthy non-pregnant women,50 cases of early stage pregnant women（14~27 weeks） and 50 cases of late stage pregnant women（28~40 weeks） were enrolled.Plasma PZ and ZPI were determined by competitive enzyme-linked immunosorbent assay（ELISA）.In addition,prothrombin time（PT）,activation partial thromboplastin time（APTT）,thrombin time（TT） and fibrinogen（Fg） content were measured by coagulation method.Results The levels of plasma PZ and ZPI decreased gradually from the non-pregnant women to the early stage pregnant women and the late stage pregnant women.Compared to the non-pregnant women,the level of plasma PZ decreased by 16.1%,and the level of ZPI decreased by 22.8% in the late stage pregnant women.Compared to the non-pregnant women,the PT and TT shortened significantly（P0.01）,and the Fg increased significantly in the early stage pregnant women and the late stage pregnant women（P0.01）.Compared to the early stage pregnant women,the PT and TT shortened significantly（P0.05）,and the Fg increased significantly in the late stage pregnant women（P0.05）.Compared to the non-pregnant women,the APTT shortened significantly in the late stage pregnant women（P0.05）.The decreased levels of PZ and ZPI were related to the shortening of PT.Conclusions The activity of blood coagulation factor and coagulation function increase in pregnant women along with the increase of gestational weeks.It may relate to a gradual decrease of the concentrations of plasma anticoagulants such as PZ and ZPI.This kind of physiological change provides a material base for the pregnant women to prepare them to stop bleeding effectively after childbirth,however,it also increases the risk of thrombosis during the pregnancy.