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目的筛选对复发性自然流产(recurrent spontaneous abortion,RSA)患者的早期诊断和干预有提示意义的血栓标志物。方法收集2012年10月至2014年10月在郑州人民医院妇产科就诊的RSA患者(排除由遗传因素、生殖器畸形等原因造成的复发性流产者)86例流产前和176例正常孕妇的6种血栓标志物[抗凝血酶Ⅲ(antithrombinⅢ,ATⅢ)、蛋白C(Protein C,PC)、纤溶酶原(plasminogen,PLG)、组织型纤溶酶原激活物(tissue plasminogen activator,t_PA)、纤溶酶原激活物抑制因子-1(plasminogen activatorinh ibitor-1,PAI-1)、交联纤维蛋白(cross-linked fibrin,CLFb)的降解产物,D-二聚体(D-dimer,D-D)]进行对比研究,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),并进行Logistic回归分析。结果根据ROC曲线图,AT、PC、PAI-1 3个血栓标志物曲线下面积分别为0.712、0.927、0.984,都>0.5,具有诊断价值;PLG、t_PA、DD 3个指标曲线下面积太小,证明其灵敏度和特异性不够好。Logistic回归分析,3个指标的判别准确率分别为82.8%、96.6%和94.7%,Sig值均<0.01,差异有统计学意义。结论 AT、PC、PAI-1这3种标志物对RSA有更灵敏的提示作用。当其检测值高于其诊断界限值时,可作为孕妇血栓处于异常状态且有自然流产可能的参考。
Objective To screen thrombus markers for early diagnosis and intervention of patients with recurrent spontaneous abortion (RSA). Methods A total of 86 RSA patients (excluding recurrent spontaneous abortions caused by genetic factors and genital malformations) in obstetrics and gynecology department of Zhengzhou People’s Hospital from October 2012 to October 2014 were collected from 86 pre-abortion and 176 normal pregnant women Thrombus markers [antithrombin Ⅲ (ATⅢ), protein C (PC), plasminogen (PLG), tissue plasminogen activator (t_PA) , Plasminogen activatorinh ibitor-1 (PAI-1), degradation products of cross-linked fibrin (CLFb), D-dimer )] Were compared to draw the receiver operating characteristic curve (receiver operating characteristic curve, ROC), and Logistic regression analysis. Results According to the ROC curve, the areas under the curves of AT, PC and PAI-1 were 0.712, 0.927 and 0.984, all of which were of diagnostic value. The areas under the three index curves of PLG, t_PA and DD were too small , Demonstrating that its sensitivity and specificity are not good enough. Logistic regression analysis showed that the discriminant accuracy rates of three indexes were 82.8%, 96.6% and 94.7%, respectively. The Sig values were all <0.01, the difference was statistically significant. Conclusion The three markers of AT, PC and PAI-1 are more sensitive to RSA. When the test value is higher than its diagnostic limit, it can be used as a reference for pregnant women with abnormal thrombus and spontaneous abortion.