Haemostatic changes in pregnancy
Haemostatic changes in pregnancy
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DOI：
10.1016/j.thromres.2004.08.004
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发表时间：
2004-01-01
影响因子：
7.5
通讯作者：
Brenner, B
中科院分区：
文献类型：
--
作者：
Brenner, B
正常妊娠时，母体血液中促凝血活性明显升高，以因子VII、X、VIII、纤维蛋白原、血管性血友病因子升高为特征，在足月前后达到最大。这与凝血酶原片段（PF1+2）和凝血酶-抗凝血酶复合物的增加有关。生理性抗凝剂的减少表现为蛋白S活性的显著降低和获得性活化蛋白C （APC）抗性的降低。总体纤溶活性在怀孕期间受损，但在分娩后迅速恢复正常。这主要是由于胎盘源性纤溶酶原激活物抑制剂2型（PAI-2），其在妊娠期间大量存在。d -二聚体是由纤溶蛋白分解交联纤维蛋白聚合物引起的纤维蛋白溶解的特异性标志物，随着妊娠的进展而增加。总的来说，在整个妊娠期和产后，血栓形成的风险增加了4到10倍。胎盘血小板成细胞水平的局部止血的特点是组织因子（TF）表达增加和抑制剂TFPI的低表达。来源于母体内皮细胞和血小板以及胎盘成血小板细胞的微粒可能有助于促凝作用。胎盘嗜血小板细胞的局部抗凝机制对促凝环境的平衡具有重要意义。抗磷脂抗体（APLA）患者的抗凝机制，如膜联蛋白V自身抗体的破坏可能增加妊娠并发症。(c) 2004 Elsevier Ltd.版权所有。
In normal pregnancy, there is a marked increase in the procoagulant activity in maternal blood characterized by elevation of factors VII, X, VIII, fibrinogen and von Willebrand factor, which is maximal around term. This is associated with an increase in prothrombin fragments (PF1+2) and thrombin-antithrombin complexes. There is a decrease in physiological anticoagulants manifested by a significant reduction in protein S activity and by acquired activated protein C (APC) resistance. The overall fibrinolytic activity is impaired during pregnancy, but returns rapidly to normal following delivery. This is Largely-due to placental derived plasminogen activator inhibitor type 2 (PAI-2), which is present in substantial quantities during pregnancy. D-dimer, a specific marker of fibrinolysis resulting from breakdown of cross-Linked fibrin polymer by plasmin, increases as pregnancy progresses. Overall, there is a 4- to 10-fold increased thrombotic risk throughout gestation and the postpartum period. Local haemostasis at the placental throphoblast level is characterized by increased tissue factor (TF) expression and low expression of the inhibitor TFPI. Microparticles derived from maternal endothelial cells and platelets, and from placental throphoblasts may contribute to the procoagulant effect. Local anticoagulant mechanisms on placental throphoblasts are important for counterbalance of the procoagulant milieu. Disruption of anticoagulant mechanisms, for example, autoantibodies, to annexin V may increase pregnancy complications in patients with antiphospholipid antibodies (APLA). (c) 2004 Elsevier Ltd. All rights reserved.