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目的探讨妇女妊娠过程中血小板参数和凝血指标的变化及临床意义。方法对2005年5月至2006年5月温州医学院附属第一医院正常妊娠妇女56例(妊娠组),检测其不同孕期(早期:12～14周、中期:24～26周、晚期:36～40周)及50例非妊娠正常妇女(非妊娠组)血小板计数(PLT)、平均血小板体积(MPV)、血小板体积分布宽度(PDW),同时采用凝固法测定血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和凝血酶时间(TT),发色底物法测定抗凝血酶活性(AT:A),免疫比浊法测定血浆D-二聚体(D-D)含量,并互相间进行比较分析。结果与非妊娠组比较,妊娠组妇女早孕期纤维蛋白原(FIB)和D-D即明显增高,AT:A和TT明显降低(P<0.01);中、晚孕期PLT和PDW显著增高,MPV、PT和APTT均显著降低(P<0.05)。早、中、晚孕期间比较,除PLT外其他各项指标差异显著(P均<0.01),其中除AT:A中孕期高于早、晚孕期外,其他各项指标均呈逐渐发展趋势。结论妊娠中、晚期妇女血小板参数明显改变,妊娠过程中凝血、抗凝和纤溶功能变化明显;这些参数的检测可及时了解孕妇的凝血状态,有利于降低产科DIC的发生率。
Objective To investigate the changes and clinical significance of platelet parameters and coagulation indexes during pregnancy in women. Methods From May 2005 to May 2006, 56 pregnant women in the first affiliated hospital of Wenzhou Medical College (pregnancy group) were enrolled in this study. Their gestational age (early stage: 12-14 weeks, middle stage: 24-26 weeks, late stage: 36 (PLT), mean platelet volume (MPV) and platelet volume distribution width (PDW) in 50 non-pregnant normal women (non-pregnant group) (APTT), fibrinogen (FIB) and thrombin time (TT), antithrombin activity (AT: A) by chromogenic substrate method, plasma D- Dimer (DD) content, and comparative analysis of each other. Results Fibrinogen (FIB) and DD in early pregnancy were significantly higher in pregnant women than those in non-pregnant women (P <0.01). The PLT and PDW were significantly increased in middle and late pregnant women. The levels of MPV, PT And APTT were significantly lower (P <0.05). During the early, middle and late pregnancy, there were significant differences in other indicators except PLT (P <0.01). Except for AT: A, the indicators of pregnancy were higher than those of early and late pregnancy, and other indicators showed a trend of gradual development. Conclusion The platelet parameters of women in the second and third trimester of pregnancy are significantly changed. The changes of coagulation, anticoagulation and fibrinolysis during pregnancy are obviously changed. The detection of these parameters can timely understand the coagulation state of pregnant women and reduce the incidence of obstetric DIC.