de Moerloose P, Mermillod N, Amiral J, Reber G
Unité d'Hémostase, Hôpital Cantonal Universitaire, Genève, Switzerland.
Thromb Haemost. 1998 Mar;79(3):554-6.
Some studies suggest that soluble thrombomodulin (TM) could be used as a marker of preeclampsia or eclampsia. However little is known about the sequential changes of TM during the course of normal pregnancy. Levels of TM were determined in 100 women with uneventful pregnancies. Samples (n = 394) were divided into five study intervals, three during pregnancy, one at delivery and one three days postpartum. As compared with TM levels (median 34.3 ng/ml, range 17.6-61) of a control group of 60 healthy non-pregnant women, TM levels were shown to increase throughout pregnancy, median (and range) values being respectively 38.5 (17.6-72.7) from 11 to 20 weeks, 45.2 (22.6-75.2) from 21 to 30 weeks and 54.3 (25.1-114.5) ng/ml from 31st week to delivery. One hour after delivery TM levels were still elevated and dropped three days postpartum to 40.5 (20.9-79.4) ng/ml. The increase of TM levels was correlated with those of tissue-type plasminogen activator and plasminogen activator inhibitor-1 antigens. The large overlap in TM levels between the study periods seems to preclude a clinical use of TM based on reference values from a control group. Our data suggest that it would be more appropriate to take into account TM baseline values in a given woman to examine her TM increase during pregnancy.
一些研究表明，可溶性血栓调节蛋白（TM）可作为先兆子痫或子痫的标志物。然而，对于正常妊娠过程中TM的连续变化知之甚少。对100例妊娠顺利的女性测定了TM水平。样本（n = 394）分为五个研究时间段，三个在孕期，一个在分娩时，一个在产后三天。与60名健康非妊娠女性对照组的TM水平（中位数34.3 ng/ml，范围17.6 - 61）相比，TM水平在整个孕期均升高，11至20周时中位数（及范围）值分别为38.5（17.6 - 72.7），21至30周时为45.2（22.6 - 75.2），第31周直至分娩时为54.3（25.1 - 114.5）ng/ml。分娩后1小时TM水平仍升高，产后三天降至40.5（20.9 - 79.4）ng/ml。TM水平的升高与组织型纤溶酶原激活物和纤溶酶原激活物抑制剂-1抗原的水平相关。研究时间段之间TM水平的大量重叠似乎排除了基于对照组参考值对TM进行临床应用。我们的数据表明，考虑特定女性的TM基线值以检查其孕期TM的升高更为合适。
