| Objective:1.To study the differences in the levels of coagulation indicators(PT、APTT、TT、FIB.FⅡ、FⅤ、FⅦ、FⅩ、FⅧ、FⅨ、FⅪ、FⅫ)and thrombosis-related indicators(AT-Ⅲ、FDP、DD、vWF:Ag、FM)in healthy pregnant women during different pregnancy periods,and observe the trend of changes in these indicators during pregnancy.2.To establish reference intervals for coagulation and thrombosis-related indexes of healthy pregnant women in different pregnancy periods,and verify the established reference intervals,it can provide reference for the prevention and diagnosis of bleeding and thrombotic diseases.Methods:From November 2019 to December 2020,371 healthy singleton pregnancies were selected,and they were all filed and given birth in the Obstetrics Department of the Second Affiliated Hospital of Kunming Medical University.Divide them into the early pregnancy group(<14 weeks)with 127 cases,123 cases in the middle pregnancy group(14～27+6 weeks)and 121 cases in the late pregnancy group(≥28 weeks).The control group included 110 healthy non-pregnant women.In each group,the levels of PT,APTT,TT,FIB,AT-Ⅲ,FDP,and DD were detected by the Sysmex CS-5100 automatic blood coagulation analyzer and supporting reagents.STA-R Evolution(?)automatic blood coagulation analyzer and supporting reagents are used to detect the levels of FⅡ,FⅤ,FⅦ,FⅩ,FⅧ,FⅨ,FⅪ,FⅫ,vWF:Ag,and FM.The Dixon method was used to eliminate outliers.The data distribution is judged by Kolmogorov-Smirnov test.The comparison between the two groups uses the Mann-Whitney U test(non-normally distributed)or independent sample t-test(normally distributed);the comparison between multiple groups uses the Kruskal-Wallis H test(non-normally distributed)or one-way analysis of variance(normally distributed).The dispersion and change trend of the above indicators are represented by box plots.According to the CLSI C28-A3 document,the non-parametric method was used to establish the reference intervals of coagulation and thrombosis-related indexes during pregnancy,and the established reference intervals was verified.Results:1.(1)Changes in coagulation indicators during pregnancy:compared with healthy non-pregnant people,the PT level has not changed throughout the pregnancy and is within the reference range of the non-pregnant level;the level of APTT is significantly reduced in the first trimester,and it is not significantly reduced in the second trimester compared with the early trimester,and it further decreases in the third trimester,reaching the lowest level;In the first trimester,the level of TT decreases greatly,and then continues to decrease,but did not decrease significantly in the late pregnancy;the levels of FⅡ and FⅤ increased significantly during the first trimester,and then remained relatively stable;the levels of FIB,FⅦ,FⅩ,FⅨ,and FⅫ gradually increase with the increase in gestational weeks,and the increase of FⅨ and FⅫ in the late pregnancy is not as obvious as that of FIB,FⅦ,and FⅩ;the level of FⅧ rises significantly in the first trimester,and decreases in the second trimester compared with the early trimester,but it is still higher than the level of non-pregnant people,it continues to rise in the third trimester and can reach twice the level of non-pregnant people;the level of FⅪ declines in the first trimester,then gradually rises,returns to the non-pregnant level in the second trimester,and reaches the highest level in the third trimester.(2)Changes in thrombosis-related indicators during pregnancy:In the first trimester,the level of AT-Ⅲ decreases greatly,and it rises in the third trimester;as the pregnancy progresses,the levels of FDP and DD continue to rise,reaching the highest in the third trimester;the level of vWF:Ag increases significantly in the first trimester,and does not change significantly in the second trimester compared with the early trimester,and further rises in the third trimester to reach the highest level;the level of FM increases significantly in the second trimester,and does not change significantly in the third trimester compared with the second trimester.2.The reference intervals of PT,APTT,TT,FIB,FⅡ,FⅤ,FⅦ,FⅩ,FⅧ,FⅨ,FⅪ,FⅫ,AT-Ⅲ,FDP,DD,vWF:Ag,FM in the first trimester are:10.2-12.Os,23.3-29.7s,13.5-16.3s,2.59-4.60 g/L,85%-140%,82%-169%,85%-179%,75%-154%,120%-392%,81%-200%,78%-136%,70%-173%,73.3%-101.9%,0.00-2.50ug/mL,0.00-0.82ug/mL,71%-229%,0.00-6.01ug/mL;the reference intervals of these indicators in the second trimester are:10.2-11.9s,23.2-29.4s,13.0-15.9s,2.59-5,10 g/L,88%-127%,83%-172%,105%-246%,92%-152%,100%-357%,86%-200%,74%-145%,72%-217%,70.5%-103.3%,0.00-4.40ug/mL,0.00-1.35ug/mL,70%-245%,0.00-13.69 ug/mL;the reference intervals of these indicators in the third trimester are:10.0-12.0s,22.8-29.4s,13.3-15.7s,3.10-5.98g/L,87%-130%,65%-164%,136%-278%,91%-159%,142%-525%,89%-200%,80%-158%,71%-214%,75.2%-113.6%,0.00-8.63ug/mL,0.00-3.40ug/mL,86%-352%,0.00-18.8 ug/mL.3.The verification results of PT,APTT,TT,FIB,FⅡ,FV,FⅦ,FⅩ,FⅧ,FⅨ,FⅪ,FⅫ,AT-Ⅲ,FDP,DD,vWF:Ag and FM reference intervals in different pregnancy periods are all in line verification standards.Conclusion:1.The hypercoagulable state of normal pregnancy has started from the first trimester,as the pregnancy progresses,this state gradually increases,reaching a peak in the third trimester,which is mainly manifested as a significant increase in coagulation function and weakened anticoagulation function.As the coagulation function in pregnant women is enhanced,in order to maintain the relative balance between the coagulation and fibrinolytic systems,the fibrinolytic activity will increase accordingly.2.Compared with healthy non-pregnant people,the level of PT during pregnancy does not change significantly,the levels of APTT,TT,FIB,FⅡ,FV,FⅦ,FⅩ,FⅧ,FⅨ,FⅪ,FⅫ,AT-Ⅲ,FDP,DD,vWF:Ag and FM have changed significantly.3.The reference intervals of coagulation and thrombus-related indicators in different pregnancy periods of healthy pregnant women have been initially established and verified,which is conducive to a more comprehensive and accurate assessment of pregnancy status,and is of great significance to the clinical decision-making of obstetricians. |
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