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目的:通过对临床资料的前瞻性分析,探讨ADAMTS13活性与妊娠期高血压之间的关系,以及由妊娠期高血压引起的凝血障碍、血栓形成之间的关系。方法:分别收集慢性高血压、子痫前期/子痫、慢性高血压并发子痫前期/子痫患者以及健康孕妇的血浆,采用剩余胶原结合法检测ADAMTS13活性;分别选取健康的正常对照组孕妇和该院诊断的慢性高血压、子痫前期/子痫、慢性高血压并发子痫前期/子痫患者,应用彩色多普勒血流显像仪检测胎盘床动脉血流参数;应用全自动血凝分析仪检测凝血系统各项指标,观察体外血栓的形成情况。结果:60例正常对照组中妊娠妇女血浆中的ADAMTS13活性随着怀孕天数的增加而下降,差异有统计学意义(P<0.05)。随着妊娠期高血压严重程度的增加,ADAMTS13活性也呈现下降趋势(P<0.05)。各类型妊娠期高血压患者的收缩期最大速度与舒张末期速度之比(S/D)、搏动指数(PI)、阻力指数(RI)与正常对照组相比均升高,时间平均流速(TAV)均降低。与正常对照组相比,各个程度妊娠期高血压患者凝血酶原时间(PT)、活化部分凝血酶时间(APTT)均缩短,人纤维蛋白原(FIB)含量均增加,血栓形成增加。结论:ADAMTS13活性在妊娠期高血压患者中明显下降,且随着妊娠期高血压程度的严重,凝血系统功能增强。提示妊娠期高血压所致的ADAMTS13活性降低可能是导致孕妇凝血障碍的重要因素之一。
Objective: To investigate the relationship between ADAMTS13 activity and gestational hypertension, and the relationship between coagulation disorders and thrombosis caused by gestational hypertension through prospective analysis of clinical data. Methods: The plasma of patients with chronic hypertension, preeclampsia / eclampsia, chronic hypertension and preeclampsia / eclampsia and healthy pregnant women were collected respectively. The activity of ADAMTS13 was detected by residual collagen binding method. The healthy pregnant women and normal pregnant women The hospital diagnosis of chronic hypertension, preeclampsia / eclampsia, chronic hypertension with preeclampsia / eclampsia, the application of color Doppler flow imaging instrument to detect placental bed blood flow parameters; the application of automatic coagulation Analyzer detects various indicators of the coagulation system to observe the formation of in vitro thrombus. Results: The activity of ADAMTS13 in the plasma of pregnant women in 60 normal controls decreased with the increase of the number of pregnant days, the difference was statistically significant (P <0.05). With the increase of the severity of gestational hypertension, ADAMTS13 activity also showed a downward trend (P <0.05). The systolic and diastolic velocities (S / D), pulsatility index (PI) and resistance index (RI) of hypertensive patients with gestational hypertension were significantly higher than those of the normal control group ) Are lower. Compared with the normal control group, the prothrombin time (PT), activated partial thromboplastin time (APTT) and the content of human fibrinogen (FIB) increased in all degree of hypertensive patients during pregnancy, and thrombosis increased. CONCLUSION: The activity of ADAMTS13 is significantly decreased in patients with gestational hypertension, and the function of the coagulation system is enhanced with the severity of pregnancy-induced hypertension. Prompted reduction of ADAMTS13 activity induced by gestational hypertension may be one of the important factors that lead to coagulation disorders in pregnant women.