Detection of Decreased Response to Activated Protein C during Pregnancy by an Endogenous Thrombin Potential-Based Assay
Detection of Decreased Response to Activated Protein C during Pregnancy by an Endogenous Thrombin Potential-Based Assay
复制标题
通过内源性凝血酶电位检测检测妊娠期间对活化蛋白 C 的反应降低
DOI：
10.1055/s-2007-994957
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发表时间：
1999
影响因子：
5.7
通讯作者：
T. Terao
中科院分区：
文献类型：
--
作者：
M. Sugimura;Takao Kobayashi;N. Kanayama;T. Terao
怀孕已被广泛认为是深静脉血栓（DVT）的诱发危险因素。然而，目前尚不清楚为什么没有家族性血栓形成倾向或抗磷脂综合征（APS）病史的孕妇在妊娠期和产褥期DVT和肺栓塞（PE）的发生率较高。我们检查了健康孕妇和产褥期 DVT 发作患者的活化蛋白 C (APC) 系统。对 60 名未经选择的没有血栓或 APS 既往史或家族史的日本孕妇以及 3 名产褥期患有 DVT 的日本妇女进行了评估。通过测定凝血活酶激活的患者血浆中的凝血酶-α2-巨球蛋白复合物来测量内源性凝血酶电位比（ETP-r）。 APC 敏感性比 (APC-sr) 通过在存在和不存在 APC 的情况下测定患者血浆中的 ETP-r 来计算（最终浓度 [浓度] 5.9 nM），以评估功能性 APC 抗凝活性。与非孕妇的平均 APC-sr (1.15 +/- 0.63) 相比，平均 APC-sr 在妊娠 30 周时显着增加 (2.35 +/- 0.72)，并在产褥期保持较高水平。 DVT 患者发病时的平均 APC-sr 显着高于产褥期的平均 APC-sr（3.57 +/- 0.54），表明基于 ETP 的检测对 APC 的敏感性降低。这些数据表明，对 APC 的功能敏感性显着降低与妊娠期间静脉血栓形成风险增加相关。
Pregnancy has been widely recognized as a predisposing risk factor for deep vein thrombosis (DVT). However, it still remains unclear why pregnant women without a history of familial thrombophilia or antiphospholipid syndrome (APS) have a higher incidence of DVT and pulmonary embolism (PE) during pregnancy and puerperium. We examined the activated protein C (APC) system in healthy pregnant women and in patients with the onset of DVT during puerperium. Sixty unselected Japanese pregnant women without a past or family history of thrombosis or APS and 3 Japanese women with DVT during puerperium were evaluated. Endogenous thrombin potential-ratio (ETP-r) was measured by determination of thrombin-alpha2-macroglobulin complexes in thromboplastin-activated patient plasma. APC sensitivity ratio (APC-sr) was calculated by the determination of ETP-r in patient plasma in the presence and absence of APC (final concentration [conc.] 5.9 nM) to evaluate the functional APC anticoagulant activity. Mean APC-sr was significantly increased at 30 weeks' gestation (2.35 +/- 0.72) and remained high during puerperium compared with the mean APC-sr in nonpregnant women (1.15 +/- 0.63). Mean APC-sr in patients with DVT at the onset was significantly higher (3.57 +/- 0.54) than mean APC-sr during puerperium was, indicating that the sensitivity to APC was reduced in the ETP-based assay. These data suggest a significant reduction in the functional sensitivity to APC associated with an increased risk of venous thrombosis during pregnancy.