正常妊娠期间蛋白C抑制剂活性降低及获得性活化蛋白C抵抗

Decrease in protein C inhibitor activity and acquired APC resistance during normal pregnancy.

作者信息

Shu H, Wramsby M, Bokarewa M, Blombäck M, Bremme K

机构信息

Department of Laboratory Medicine/Coagulation Research, Karolinska Institutet, Stockholm, Sweden.

出版信息

J Thromb Thrombolysis. 2000 Apr;9(3):277-81. doi: 10.1023/a:1018726930407.

DOI:10.1023/a:1018726930407

PMID:10728028

Abstract

BACKGROUND

Since protein C inhibitor (PCI) inhibits activated protein C (APC) and a number of proteases, one would expect lower concentrations of PCI in a hypercoagulable state due to increased consumption of the inhibitor. Normal pregnancy is associated with a state of activated hemostasis, where response to APC is depressed. We aimed to study whether PCI function varies during normal pregnancy, and assess the relationship between this inhibitor and acquired APC resistance.

METHODS

PCI activity in plasma was tested during pregnancy and postpartum in 28 healthy pregnant women without factor V Leiden Arg(506) - Gln mutation and in 14 non-pregnant female controls. The PCI levels determined in the present study was compared to the APC ratio (APC-r), we investigated previously, in the same samples.

RESULTS

The levels of PCI in the pregnant group, as compared to that in the control group (4.74 +/- 0.48), gradually decreased from the first to the third trimester, i.e., 3.30 +/- 1.31 microg/mL in week 12 (p < 0.001), 2.66 +/- 1.44 microg/mL in week 20 (p < 0.001), 1.92 +/- 1.18 microg/mL in week 28 (p < 0.001), 1.30 +/- 0.94 microg/mL in week 32 (p < 0.001) and 1.49 +/- 1.12 microg/mL in week 37 (p < 0.001). After delivery, they rose to 5.02 +/- 1.93 microg/mL, similar to that in the controls (p > 0.05). The values of APC-r showed the same tendency during gestation and postpartum.

CONCLUSION

With advance of normal pregnancy, decreasing PCI function corresponds to increasing APC resistance, probably due to that activated hemostasis acts as a link connecting the two variables.

摘要

背景

由于蛋白C抑制剂（PCI）可抑制活化蛋白C（APC）及多种蛋白酶，人们预期在高凝状态下，由于抑制剂消耗增加，PCI浓度会降低。正常妊娠与活化止血状态相关，此时对APC的反应会受到抑制。我们旨在研究正常妊娠期间PCI功能是否会发生变化，并评估该抑制剂与获得性APC抵抗之间的关系。

方法

对28例无因子V莱顿Arg(506)-Gln突变的健康孕妇及其产后和14例非妊娠女性对照者进行血浆PCI活性检测。将本研究中测定的PCI水平与我们之前在相同样本中研究的APC比值（APC-r）进行比较。

结果

与对照组（4.74±0.48）相比，妊娠组PCI水平从孕早期到孕晚期逐渐降低，即孕12周时为3.30±1.31μg/mL（p<0.001），孕20周时为2.66±1.44μg/mL（p<0.001），孕28周时为1.92±1.18μg/mL（p<0.001），孕32周时为1.30±0.94μg/mL（p<0.001），孕37周时为1.49±1.12μg/mL（p<0.001）。产后，其升至5.02±1.93μg/mL，与对照组相似（p>0.05）。APC-r值在妊娠期和产后呈现相同趋势。