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[不明原因宫内死胎女性的遗传性血栓形成因素]

[Inherited thrombophilic factors in women with unexplained intrauterine fetal deaths].

作者信息

Ivanov P, Komsa-Penkova R, Konova E, Kovacheva K, Ivanov I, Ivanov M, Tanchev S

出版信息

Akush Ginekol (Sofiia). 2009;48(4):3-7.

Abstract

The aim of the study was to investigate a relationship between carrier status for factor V Leiden (FVL), prothrombin gene mutation 20210 G>A (PTM 20210 G>A) and development of unexplained intrauterine fetal deaths (UIFD). Thirty three women with one or more UIFD and stillbirths were investigated for carriers status for FVL and PTM 20210 G>A. Women with multiple pregnancies, congenital anomalies, intrauterine infection or chorioamnionitis were excluded from the study. Control group consisted of 79 women without reproductive failure were selected and investigated. The prevalence of FVL was significantly higher in the study group (21.1%) compared with 6.3% in the control group (OR 3.98, 95% CI 1.02- 16.14, p = 0.045). The prevalence of PTM 20210 G>A was also much higher in patients (10%) than in controls (2.5%) (OR 3.85, 95% CI 0.49-35.08, p-ns). Seven patients with UIFD and other obstetrics complications (preeclampsia, placental abruption, intrauterine growth retardation) showed high prevalence (over 40%) of FVL and PTM 20210 G>A. We found an important association between UIFD and FVL and PTM 20210 G>A, although the data on PTM 20210 G>A was non-significant because of low rate of the mutation and small group of investigated women. This data serves as a background to suggest a routine testing for inherited thrombophilia in women with UIFD aiming and individual approach of preventive use of low-molecular-weight heparin to avoid obstetric complication in future pregnancy.

摘要

本研究的目的是调查凝血因子V莱顿(FVL)携带者状态、凝血酶原基因突变20210 G>A(PTM 20210 G>A)与不明原因宫内胎儿死亡(UIFD)发生之间的关系。对33例有一次或多次UIFD及死产的女性进行了FVL和PTM 20210 G>A携带者状态调查。多胎妊娠、先天性异常、宫内感染或绒毛膜羊膜炎的女性被排除在研究之外。对照组由79例无生殖功能衰竭的女性组成并进行调查。研究组中FVL的患病率(21.1%)显著高于对照组(6.3%)(OR 3.98,95%CI 1.02 - 16.14,p = 0.045)。患者中PTM 20210 G>A的患病率(10%)也远高于对照组(2.5%)(OR 3.85,95%CI 0.49 - 35.08,p无统计学意义)。7例患有UIFD及其他产科并发症(先兆子痫、胎盘早剥、胎儿宫内生长受限)的患者中FVL和PTM 20210 G>A的患病率较高(超过40%)。我们发现UIFD与FVL和PTM 20210 G>A之间存在重要关联,尽管由于突变率低和调查女性数量少,关于PTM 20210 G>A的数据无统计学意义。这些数据为建议对UIFD女性进行遗传性血栓形成倾向的常规检测提供了依据,旨在采取个体化方法预防性使用低分子量肝素以避免未来妊娠中的产科并发症。

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