Hallak M, Senderowicz J, Cassel A, Shapira C, Aghai E, Auslender R, Abramovici H
Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48235, USA.
Am J Obstet Gynecol. 1997 Apr;176(4):889-93. doi: 10.1016/s0002-9378(97)70617-3.
Our purpose was to evaluate activated protein C resistance phenotype and genotype among patients with thrombosis during pregnancy and the puerperium.
This observational study was conducted prospectively during a 2-year period (July 1993 to June 1995) in a preselected population. All patients admitted to our high-risk pregnancy unit with a diagnosis of deep vein thrombosis, pulmonary emboli, transient ischemic attack, and cerebrovascular accident during pregnancy and the puerperium were included. Prothrombin time, partial thromboplastin time, fibrinogen levels, protein C, protein S, antithrombin III, functional test for activated protein C resistance, and factor V Leiden mutation by polymerase chain reaction were performed on each patient.
Fifteen patients were included. Seven (46.6%) patients were positive for activated protein C resistance (factor V Leiden). All other coagulation studies were negative for all patients. All patients with activated protein C resistance had a venous thrombotic event, deep vein thrombosis, or pulmonary emboli, and only one had a cerebrovascular accident on the basis of sagittal sinus thrombosis. Only two of the activated protein C resistance-negative patients had venous thrombosis (pulmonary emboli). The remaining six patients had transient ischemic attacks or cerebrovascular accidents. For the subgroup with venous thrombosis during pregnancy and the puerperium, the incidence of activated protein C resistance (factor V Leiden) was 78%.
This study demonstrates the incidence of factor V Leiden in a selected population in whom thrombotic events developed during pregnancy and the puerperium. This small-scale study provides justification for a large cohort study that will identify women with factor V Leiden and determine their risk for thrombosis during pregnancy and the puerperium. We believe that factor V Leiden should be evaluated in conjunction with thrombotic events in the pregnant woman.
我们的目的是评估妊娠和产褥期血栓形成患者的活化蛋白C抵抗表型和基因型。
这项观察性研究于1993年7月至1995年6月的2年期间在一个预先选定的人群中进行前瞻性研究。纳入所有在我们高危妊娠病房因妊娠和产褥期诊断为深静脉血栓形成、肺栓塞、短暂性脑缺血发作和脑血管意外而入院的患者。对每位患者进行凝血酶原时间、部分凝血活酶时间、纤维蛋白原水平、蛋白C、蛋白S、抗凝血酶III、活化蛋白C抵抗功能试验以及通过聚合酶链反应检测因子V莱顿突变。
纳入15例患者。7例（46.6%）患者活化蛋白C抵抗（因子V莱顿）呈阳性。所有其他凝血研究对所有患者均为阴性。所有活化蛋白C抵抗阳性的患者均发生静脉血栓事件、深静脉血栓形成或肺栓塞，只有1例因矢状窦血栓形成发生脑血管意外。活化蛋白C抵抗阴性的患者中只有2例发生静脉血栓形成（肺栓塞）。其余6例患者发生短暂性脑缺血发作或脑血管意外。对于妊娠和产褥期发生静脉血栓形成的亚组，活化蛋白C抵抗（因子V莱顿）的发生率为78%。
本研究证明了在妊娠和产褥期发生血栓事件的特定人群中因子V莱顿的发生率。这项小规模研究为一项大型队列研究提供了依据，该研究将识别出携带因子V莱顿的女性，并确定她们在妊娠和产褥期发生血栓的风险。我们认为，对于孕妇的血栓事件，应结合因子V莱顿进行评估。
