妊娠糖尿病孕妇糖化血红蛋白与部分止凝血指标活性的相关性

目的探讨妊娠糖尿病（GDM）孕妇的部分凝血、纤溶指标活性的变化及其与糖化血红蛋白（GHbA1c）的相关性。方法对正常非孕妇女、正常妊娠妇女（各40例）和GDM孕妇（50例）的GHbA1c、血浆Ⅶc因子（FⅦc）、组织型纤溶酶原激活物（t-PA）及其抑制物（PAI-1）、蛋白C活性依赖凝固时间（PCAT）及抗凝血酶-Ⅲ（AT-Ⅲ）等指标进行检测，并分析糖化血红蛋白与各指标之间的相关性。结果与正常非孕组及正常妊娠组比较，GDM组GHbA1c、FⅦc、PAI-1均显著增高（P〈0．01），t-PA明显下降（P〈0．01）；正常妊娠组AT-Ⅲ较非孕组呈下降趋势，GDM患者AT-Ⅲ水平、PCAT与正常妊娠组无显著差异。全部GDM患者GHbA1c与t-PA呈负相关（r=-0．607．P〈0．01），与PAI-1呈正相关（r=0．493，P〈0．01），与FⅦc活性正相关（r=0．421，P〈0．01）。结论糖尿病孕妇存在着明显的血栓前状态，血糖通过影响纤溶凝血系统功能，导致凝血功能异常，在妊娠糖尿病的发生发展中起着重要的作用。提示应密切关注患者糖化血红蛋白及凝血纤溶指标的变化，预防并发症的发生。

Correlation between GHbAlc and Coagulative Activity, Fibrinolytic Activity in Patients with Gestational Diabetes Mellitus

Objective To study the changes of coagulation function and fibrinolytic system in patients with gestational diabetes mellitns （GDM）, and to investigate the correlation between GHbA1c and the index. Method Forty non-pregnant women, 40 with normal pregnancy and 50 with GDM were enrolled in this study for the examinations of GHbA1c, activity of Coagulation FactorⅦc, tissue-type plasminogen activator （t-PA）, plasminogen activator inhibitor （PAI-1）, antithrombin m （AT-Ⅲ） and ProC. Result GHbA1c, FⅦc and PAI-1 were significantly elevated while t-PA was lower in GDM patients when compared with the non-pregnant women and women with normal pregnancy （P〈0.01）. AT-Ⅲ and ProC measurement showed no significant differences between GDM patients and women in the normal pregnancy group. There were positive correlations between the level of GHbA1c and activity of F Ⅶ c and PA I-1 in GDM patients. However the level of GHbA1c was negatively correlated with t-PA activity. Conclusion GDM women have the state of significant hypercoagnlation. Serum GHbA1c may play an important role in the pathogenesis of GDM by inducing coagulative and fihrinolytic dysfunctions. The detection of blood fibrinolyic activity and the coagulation function can be useful for prevention of complications of GDM.