[1]刘伟靓,姚丽*,曹士红,等.复发性自然流产患者血栓标志物及其诊断界限值的研究[J].中国计划生育和妇产科,2017,(11):24-27.
　LIU Wei-liang,YAO Li*,CAO Shi-hong,et al.Study on thrombus markers and their diagnostic threshold in patients with recurrent spontaneous abortion[J].Chinese Journal of Family Planning & Gynecotokology,2017,(11):24-27.
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复发性自然流产患者血栓标志物及其诊断界限值的研究
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《中国计划生育和妇产科》[ISSN:1674-4020/CN:51-1708/R]

卷:
期数:
2017年11期
页码:
24-27
栏目:
论著与临床
出版日期:
2017-11-25

文章信息/Info

Title:
Study on thrombus markers and their diagnostic threshold in patients with recurrent spontaneous abortion
作者:
刘伟靓; 姚丽*; 曹士红; 侯箐岚; 苗凤台
郑州人民医院妇产科
Author(s):
LIU Wei-liang;  YAO Li*;  CAO Shi-hong;  HOU Jing-lan;  MIAO Feng-tai
Department of Obstetrics and Gynecology, People’s Hospital of Zhengzhou，Zhengzhou Henan 450003, P.R.China
关键词:
复发性自然流产; 血栓标志物; 受试者工作特征曲线; Logistic回归
Keywords:
recurrent spontaneous abortion; thrombus markers; receiver operator characteristic curve; Logistic regression analysis
分类号:
R 71421
摘要:
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（antithrombin Ⅲ,AT Ⅲ）、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。
Abstract:
ObjectiveTo screen out thrombus markers with the significance on suggesting the early diagnosis and intervention of recurrent spontaneous abortion(RSA) patients. Methods [WTBZ〗Levels of 6 thrombus markers ［antithronmbin III (AT-III), protein C (PC), plasminogen (PLG), tissue plasminogen activator (t_PA), plasminogen activator inhibitor-1 (PAI-1) and fibrin degradation products D-Dimer (DD)］ of 86 RSA patients before their abortion and of 176 normal gravidas in People’s Hopsital of Zhengzhou from November 2012 to Novemben 2014 were analyzed contrastively. Then receiver operator characteristic (ROC) curves were drawn and Logistic regression analysis was conducted. ResultsAccording to ROC curve, areas under curve(AUC) of AT, PC and PAI-1 were 0.712, 0.927 and 0.984 respectively, which were more than 0.5, indicating diagnostic value; while AUCs of PLG, t_PA and DD were too small, suggesting poor sensitivity and specificity. Through Logistic regression analysis, the accuracy rates of the 3 indexes were 82.8 %, 96.6 % and 94.7 % respectively, and all of their Sig values were less than 0.01 with statistical significance. ConclusionAT, PC and PAI-1 are more sensitive implications for RSA. In addition, when detection values of these 3 indicators are respectively more than diagnostic limits, it suggests that thrombus of gravida was in abnormal conditions with risk of RSA.

参考文献/References:

［1］曹晓敏，苏园园，何茜冬，等.精子因素对不明原因复发性流产的影响　［J］.实用医学杂志，2010，26（17）：3142-3144. ［2］王永霞.复发性自然流产的病因研究进展　［J］.中国全科医学，2012，15（26）：3086-3088. ［3］KAJII E.Molecular approaches to the Rh blood group system　［J］.Nihon Hoigaku Zasshi, 2006, 60(2): 110-119. ［4］NASSERI F, MAMOURI G A, BABAEI H.Intravenous immunoglobulin in ABO and Rh hemolytic diseases of newborn　［J］.Saudi Medical Journal, 2006, 27(12): 1827-1830. ［5］REY E, KAHN S R, DAVID M, et al.Thrombophilic disorders and fetal loss: a meta-analysis　［J］.Lancet, 2003, 361(9361): 901-908. ［6］BRENNER B.Inherited thrombophilia and fetal loss　［J］.Current Opinion in Hematology, 2000, 7(5): 290-295. ［7］KUTTEH W H, TRIPLETT D A.Thrombophilias and recurrent pregnancy loss　［J］.Seminars in Reproductive Medicine, 2006, 24(1): 54-65. ［8］BRENNER B.Thrombophilia and pregnancy loss in first intended pregnancy　［J］.Journal of Thrombosis and Haemostasis, 2005, 3(10): 2176-2177. ［9］PIHUSCH R, BUCHHOLZ T, LOHSE P, et al.Thrombophilic gene mutations and recurrent spontaneous abortion: Prothrombin mutation increases the risk in the first trimester　［J］.American Journal of Reproductive Immunology, 2001, 46(2): 124-131. ［10］MORRISSEY P E, RAMIREZ P J, GOHH R Y, et al.Management of thrombophilia in renal transplant patients　［J］. American Journal of Transplantation, 2002, 2(9): 872-876. ［11］Preston FE, Rosendeal FR, Walker ID, et al.Increased fetal loss in women with feritsble thrombophilia ［J］.Lancet, 1996, 348: 913-916. ［12］RAZIEL A, KORNBERG Y, FRIEDLER S.Hypercoaglable thrombophilic defects and hyperhomocysteinemia in patients with recurrent pregnancy loss　［J］.American Journal of Reproductive Immunology, 2001, 45(2): 65-71. ［13］陈卫中，倪宗瓒，潘晓平，等.用ROC曲线确定最佳临界点和可疑值范围　［J］.现代预防医学，2005，32（7）：729-731. ［14］叶跃红，李兴禄.抗凝血酶Ⅲ活性在几种易栓症疾病中的研究　［J］.重庆医科大学学报，2004，29（2）：208-210. ［15］马水清，白春梅，盖铭英，等.抗凝缺陷在自然流产发病中的作用　［J］.中华围产医学杂志，2003，6（1）：17-20. ［16］YAMADA H, KATO E H, KOBASHI G, et al.Recurrent pregnancy loss:etiology of thrombophilia　［J］. Seminars in Thrombosis and Hemostasis, 2001, 27(2): 121-129. ［17］WENSTROM K D, JOHANNING G L, OWEN J, et al.Role of amniotic fluid homocysteine level and of fetal 5,10-methylene tetrahydrofolate reductase genotype in the etiology of neural tube defects　［J］.American Journal of Medical Genetics, 2000, 90(1): 12-16.

更新日期/Last Update: 2017-11-25