Okamiya H
Department of Obstetrics and Gynecology, School of Medicine, Kyorin University, Tokyo.
Nihon Sanka Fujinka Gakkai Zasshi. 1990 Nov;42(11):1557-64.
In this study, blood coagulation and fibrinolytic parameters were measured in maternal blood and fetal umbilical cord blood in 200 normal pregnant women and in 46 with severe toxemia of pregnancy (Toxemia), and the relationships between fetal growth and concentrations protein C (PC), antithrombin-III (AT-III) and alpha 2-plasmin inhibitor (alpha 2-PI) were studied. 1. Significant increases in fibrin degradation products (FDP) and in plasminogen (Plg), AT-III and PC were found in maternal blood of Toxemia. A significant increase in AT-III and a decrease in alpha 2-PI and PC were observed in cord blood from these patients. 2. The platelet count (Pl) tended to be low in patients with Toxemia complicated by fetal growth retardation (IUGR). 3. Pl and fibrinogen (Fib) tended to be high in Toxemia complicated by normal fetal growth. 4. PC increased from early pregnancy, and a further increase was observed in the puerperium. 5. The PC concentration correlated with the AT-III but not with the alpha 2-PI concentration in maternal blood. 6. PC in cord blood was lower than that in maternal blood, and was correlated with AT-III and alpha 2-PI. 7. In patients with Toxemia, PC was reduced in both maternal and cord blood, and this correlated with AT-III as well as alpha 2-PI in maternal blood. 8. PC was low in Toxemia complicated by hypertension and proteinuria. These results suggest the involvement of FDP, AT-III, PC and Plg in the pathogenesis of Toxemia, and that the Pl, Fib, FDP and alpha 2-PI concentrations are related to fetal growth. Therefore, the PC and AT-III concentrations appeared to be a useful index for the blood coagulation and fibrinolysis in pregnant women and appeared to be important factors in the degree of Toxemia and IUGR.
本研究检测了200例正常孕妇及46例重度妊娠中毒症（子痫）患者母血和胎儿脐带血中的凝血及纤溶参数，并研究了胎儿生长与蛋白C（PC）、抗凝血酶III（AT-III）及α2-纤溶酶抑制剂（α2-PI）浓度之间的关系。1. 子痫患者母血中纤维蛋白降解产物（FDP）、纤溶酶原（Plg）、AT-III和PC显著升高。这些患者脐带血中AT-III显著升高，α2-PI和PC降低。2. 合并胎儿生长受限（IUGR）的子痫患者血小板计数（Pl）往往较低。3. 合并正常胎儿生长的子痫患者Pl和纤维蛋白原（Fib）往往较高。4. PC从妊娠早期开始升高，产褥期进一步升高。5. 母血中PC浓度与AT-III相关，但与α2-PI浓度无关。6. 脐带血中的PC低于母血中的PC，并与AT-III和α2-PI相关。7. 子痫患者母血和脐带血中的PC均降低，且与母血中的AT-III和α2-PI相关。8. 合并高血压和蛋白尿的子痫患者PC较低。这些结果提示FDP、AT-III、PC和Plg参与了子痫的发病机制，且Pl、Fib、FDP和α2-PI浓度与胎儿生长有关。因此，PC和AT-III浓度似乎是孕妇凝血和纤溶的有用指标，且似乎是子痫和IUGR严重程度的重要因素。
