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目的 分析正常早期妊娠凝血4项与血栓前状态分子标志物,了解妊娠后凝血、血栓形成、抗凝和纤溶状态的改变.方法 选取2005年4月至2009年6月于中山大学孙逸仙纪念医院定期产检的105例妊娠10～12周的孕妇为研究组,另选取82例正常未孕者为对照组.测定凝血常规4项(凝血酶时间、活化部分凝血活酶时间、血浆凝血酶原时间及纤维蛋白原)及血栓前状态分子标志物[凝血酶原片段(F1+2)、血栓调节蛋白(TM)、凝血酶-抗凝血酶复合物(TAT)、抗凝血酶-Ⅲ(AT-Ⅲ)、血小板颗粒糖蛋白140(GMP140)、血栓烷B2(TXB2)、D二聚体(D-Ⅱ)、纤溶酶原激活物抑制物(PAI-2)].结果 Fg、F1 +2、TAT、GMP140、D-Ⅱ、PAI-2两组比较差异有统计学意义(P＜0.01),前者分别为4.00 g/L、0.66 nmol/L、179.95 μg/L、9.42 μg/L、201.51 μg/L、0.047 g/L,后者分别为2.52 g/L、0.31 nmol/L、39.46 μg/L、19.13 μg/L、125.02 μg/L、0.006 g/L.结论 正常妊娠早期血液凝血功能明显增高,抗凝水平略升高、纤溶活性及抗纤溶活性亦出现明显亢进,4者在较高水平保持平衡,血小板活化状况保持在低水平.

Objective To assess the changes in coagulation,thrombosis,anti-coagulation and fibrinolysis during early pregnancy.Methods A total of 105 gravidas with monocyetic pregnancies between 10 and 12 weeks gestational age at Sun Yat-sen Memorial Hospital,Sun Yat-sen University during April 2005 to June 2009 were recruited for study group and another 82 non-pregnant women as control group.Coagulation parameters,including thrombin time (TT),activated partial thromboplastin time (APTT),prothrombin (PT) and fibrinogen (Fg),were measured.We also tested the prothrombotic state parameters,including prothrombin fragment 1 + 2 (F1 + 2),thrombomodulin (TM),thrombin-antithrombin complex (TAT),antithrombin Ⅲ (AT-Ⅲ),GMP140,thromboxane B2 (TXB2),plasminogen activator inhibitor (PAI-2 ; performed by enzyme-linked immunosorbent assay) and D-dimer (D2 ; tested by latex turbidimetric immunoassay).Results Fg (4.00 vs 2.52 g/L),F1 + 2 (0.66 vs 0.31 nmol/L),TAT (179.95 vs 39.46 μg/L),GMP140 (9.42 vs 19.13 μg/L),D2 (201.51 vs 125.02 μg/L) and PAI-2 (0.047 vs 0.006 g/L) were statistically different between the study and control groups (P ＜ 0.01).Conclusions The coagulation,fibrinolysis and anti-fibrinolysis functions of healthy pregnant women become enhanced during early pregnancy while anti-coagulation function slightly increases.These four basic functions are balanced at a higher level so that the activation of platelets stays at a lower level.