Bonnar J, Redman C W, Denson K W
Perspect Nephrol Hypertens. 1976;5:85-93.
The coagulation and fibrinolytic systems play a key role in maintaining the integrity and patency of the vascular compartment. Pregnancy induces extensive physiological changes in these systems, thus creating an enhanced capacity to produce fibrin and a diminished ability to remove it. Fibrin deposition localized to the uteroplacental circulation is a feature of normal pregnancy. In women with fatal eclampsia, disseminated intravascular coagulation with fibrin deposition in the renal glomeruli is well documented. The condition of preeclampsia is not well defined. Nonetheless, evidence of intravascular coagulation, as shown by elevated levels of fibrin degradation products and reduced platelet counts, has been found in many women with preeclampsia. Serial studies showed that thrombin generation, as indicated by the ratio of factor VIII-related antigen to factor VIII coagulant activity, is considerably in excess of that which occurs in normal pregnancy, and its appearance coincides with the development of the clinical features of preeclampsia. Heparin therapy has bot been proven of value in established preeclampsia, but this fact does not disprove that role that intravascular coagulation may play in the pathogenesis of the disease. A controlled trial ina high-risk group of low-dose he;arin and an antiplatelet agent from the 16th to the 18th weeks of pregnancy onwards is required to elucidate the role of intravascular coagulation in preeclapmsia and its effect on the fetus.
凝血和纤维蛋白溶解系统在维持血管腔的完整性和通畅性方面起着关键作用。妊娠会引起这些系统广泛的生理变化，从而增强了产生纤维蛋白的能力，并降低了清除纤维蛋白的能力。局限于子宫胎盘循环的纤维蛋白沉积是正常妊娠的一个特征。在患有致命子痫的女性中，肾小球内有纤维蛋白沉积的弥散性血管内凝血已有充分记录。先兆子痫的情况尚未明确界定。尽管如此，在许多先兆子痫女性中已发现血管内凝血的证据，如纤维蛋白降解产物水平升高和血小板计数降低所示。系列研究表明，以因子VIII相关抗原与因子VIII凝血活性之比表示的凝血酶生成明显超过正常妊娠时的水平，并与先兆子痫临床特征的出现同时发生。肝素治疗在已确诊的先兆子痫中尚未被证明有价值，但这一事实并不能否定血管内凝血可能在该疾病发病机制中所起的作用。需要在高危组中进行一项从妊娠第16周到第18周起使用低剂量肝素和抗血小板药物的对照试验，以阐明血管内凝血在先兆子痫中的作用及其对胎儿的影响。
