妊娠高血压综合征患者外周血CD62P、CD63检测的临床意义

目的探讨妊娠高血压综合征(妊高征)患者、正常妊娠早期、中期、晚期妇女血小板活化状态、血小板指标、凝血功能指标的变化,探讨其对妊高征患者血栓前状态的临床预测及诊治价值。方法随机选取22例妊高征患者(妊高征组)、71例正常妊娠妇女(妊娠早期组24例、妊娠中期组23例、妊娠晚期组24例)和22例正常体检妇女(健康对照组)作为研究对象,运用流式细胞仪、血细胞分析仪、血凝仪观察各组血小板上CD62P、CD63的表达及血小板(PLT)、血小板压积(PCT)、血小板体积(MPV)、血小板宽度(PDW)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fbg)等含量。结果妊高征组CD62P含量明显上调,与妊娠早期组、妊娠中期组和妊娠晚期组比较,差异具有统计学意义(分别P0.01、P0.01、P0.05);妊高征组CD63表达量也高于妊娠早期组、妊娠中期组及妊娠晚期组,但差异无统计学意义(P0.05)。妊娠晚期组CD62P表达量明显高于妊娠早期组及妊娠中期组,差异具有统计学意义(P0.01)。妊娠晚期组的PLT含量显著高于妊娠早期和妊娠中期组的孕妇(分别P0.01、P0.05)。妊高征组PLT含量减少,与妊娠早期组、妊娠中期组及妊娠晚期组相比差异无统计学意义(P0.05)。PLT与CD62P呈负相关(r=-0.256,P0.05);PLT与CD63呈负相关(r=-0.336,P0.01)。CD62P与CD63呈正相关(r=0.303,P0.01)。CD62P、CD63、PLT、MPV、PCT、PDW、PT、Fbg指标在妊娠晚期组、妊高征组和健康对照组之间差异有统计学意义(P0.01)。妊娠晚期组MPV、PDW、PT、Fbg与健康对照组相比明显上调,差异具有统计学意义(P0.01);TT与健康对照组相比明显下调,差异具有统计学意义(P0.01)。妊高征组CD62P、CD63、PDW、Fbg与健康对照组相比明显上调,差异具有统计学意义(P0.01);PLT、PCT与健康对照组相比明显下调,差异具有统计学意义(P0.01)。妊高征组CD62P与妊娠晚期组相比明显上调,差异具有统计学意义(P0.05);MPV、PCT、PT、Fbg指标与妊娠晚期组相比明显下调,差异具有统计学意义(P0.05)。联合检测CD62P和CD63诊断妊高征敏感性为77.3%,特异性为67.6%,假阳性率为32.4%,假阴性率为22.7%,阳性预测值为42.5%,阴性预测值为90.6%。结论流式细胞术检测CD62P、CD63比血小板和凝血功能指标更能反映血栓形成倾向,对妊高征的防治具有重要价值。

Clinical Significance of Measuring Serum CD62P and CD63 in Patients with Pregnancy Induced HypertensionSydrome

Objective To study the predictive and diagnostic value for pre - thrombus status according to the changes of platelet activation, platelet count and parameters, coagulation function parameters in patients with pregnancy induced hypertension (PIH),early-pregnant women,middle-pregnant women and late-pregnant women. Methods Twenty-two patients with PIH were selected as research group randomly, The control group included Seventy-one, normal pregnancy women and twenty-two normal non-pregnant women. The expression of CD62P and CD63 in peripheral blood were measured by flow cytometry,the quantities of the blood platelet were determined by Cell-DNY 3700,the antithrombosis and thrombolysis system were measured by thrombosis auto-analyze. Results CD62P in PIH was significant higher than that of early and middle and latepregnancy women (F<0. 01 ,P< 0. 01 ,P<0. 05). The expression of CD63 in PIH was higher than others normal pregnancy women without significant deference(P >0. 05). The CD62P and PLT in late-pregnant women were higher than that of early and middle, pregnant women significantly . The Platelet count in PIH declined, without significant difference comparing with ohters pregnancy women(P>0. 05). Platelet count was negative correlated with CD62P(r= - 0. 256, P<0. 05) and CD63 (r= - 0. 336, P<0. 01) remarkably. The level of CD62P was positive correlated remarkably with CD63(r=0. 303,P<0. 01). CD62P、CD63、PLT、MPV、PCT、PDW、PT、Fbg existed significant difference among late-pregnant women,PIH and normal controls(P<0. 01). MPV、PDW、PT、Fbg were increased obviously in late-pregnant women(P<0. 01)comparing with control, but TT was declined significantly(P<0. 01),CD62P、CD63、 PDW、Fbg were increased obviously , but PLT and PCT were dropped in PIH women(P<0. 01)comparing with normal control, as to CD62P, it was increased obviously(P<0. 01), but MPV、PCT、PT、Fbg were dropped in PIH women(P<0. 01)comparing with late-pregnant women. Combined with CD62P and CD63,the sensitivity was 77. 3% ,the specificity was 67. 6% ,the false positive ratio was 32. 4%, the false negative ratio was 22. 7%, the positive predictive value was 42. 5%, the negative predictive value was90. 6%. Conclusion Detecting CD62P and CD63 by flow cytometry could indicate the pre-thromb better than that of platelet parameters and coagulation function parameters, it play an important role in preventing and treating PIH.