Changes in coagulation and hemodynamics during pregnancy: a prospective longitudinal study of 58 cases
Changes in coagulation and hemodynamics during pregnancy: a prospective longitudinal study of 58 cases
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妊娠期凝血和血流动力学变化：58例前瞻性纵向研究
DOI：
10.1007/s00404-011-2137-x
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发表时间：
2012-05-01
影响因子：
2.6
通讯作者：
Zhang Jianping
中科院分区：
文献类型：
--
作者：
Chen Hui;Meng Lili;Zhang Jianping
目的探讨正常妊娠妇女凝血、抗凝、纤溶、抗纤溶及血流动力学指标的变化，建立正常妊娠妇女血液动力学指标的参考值。在妊娠第10 - 14周、第20 - 24周和第30 - 34周进行血液和超声检查。结果妊娠早期血浆纤维蛋白原、凝血酶时间、纤维连接蛋白、凝血酶原激活片段1+2和血栓调节蛋白水平均高于对照组（P< 0.05）。纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、血栓素B2、凝血酶原激活片段1+2、血栓调节蛋白、D-二聚体、纤溶酶原激活物抑制物-2在中孕组与对照组比较差异有统计学意义（P< 0.05）。同时，纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、纤连蛋白、血栓素B2、凝血酶原激活片段1+2、血栓调节蛋白、纤溶酶原激活物抑制物2在孕晚期均明显高于对照组（P< 0.05）。此外，纤维蛋白原，血栓素B2，凝血酶原激活片段1+2，D-二聚体纤溶酶原，激活物抑制剂-2在怀孕期间逐渐增加，有一定的波动。凝血酶原时间，活化部分凝血活酶时间，凝血酶时间，国际标准化比率，血栓调节蛋白以及收缩/舒张比，脉动指数，阻力指数在子宫动脉呈下降趋势，在怀孕women.ConclusionsCoagulation，抗凝，纤溶和抗纤溶活性增强和平衡在较高的水平在怀孕期间。此外，子宫动脉和脐动脉血流动力学变得更有利于婴儿（即，高流动性和低阻力）。
PurposeTo investigate changes and establish reference values in coagulation, anticoagulation, fibrinolysis, anti-fibrinolysis and hemodynamics during normal pregnancy.MethodsA total of 58 women with singleton pregnancies were recruited. Blood and ultrasound examinations were performed in the 10th–14th, 20th–24th, and 30th–34th weeks of pregnancy. The same examinations were performed in 50 non-pregnant women who were selected as the control group.ResultsLevels of fibrinogen, thrombin time, fibronectin, prothrombin activated fragments 1+2 and thrombomodulin were higher in early pregnancy than those in the control group (P< 0.05). Fibrinogen, prothrombin time, activated partial thromboplastin time, thrombin time, thromboxane B2, prothrombin activated fragments 1+2, thrombomodulin, D-dimer, and plasminogen activator inhibitor-2 were statistically different between the mid pregnancy and the control group (P< 0.05). Meanwhile, fibrinogen, prothrombin time, activated partial thromboplastin time, thrombin time, fibronectin, thromboxane B2, prothrombin activated fragments 1+2, thrombomodulin, and plasminogen activator inhibitor-2 were obviously elevated in late pregnancy as compared with the control group (P< 0.05). Moreover, fibrinogen, thromboxane B2, prothrombin activated fragment 1+2, D-dimer plasminogen, and activator inhibitor-2 gradually increased during pregnancy with some fluctuation. Prothrombin time, activated partial thromboplastin time, thrombin time, international normalized ratio, and thrombomodulin as well as systolic/diastolic ratio, pulsatility index, and resistance index in uterine arteries showed a tendency to decrease in pregnant women.ConclusionsCoagulation, anti-coagulation, fibrinolytic and anti-fibrinolytic activities are enhanced and balanced at a higher level during pregnancy. In addition, uterine artery and umbilical artery hemodynamics become more baby friendly (i.e., high flow and low resistance).