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目的观察胎盘早剥新生儿脐血与产妇静脉血血管性血友病因子(VWF)及血管性血友病因子裂解酶(ADAMTS13)水平变化,探讨胎盘早剥新生儿凝血功能异常的病理机制。方法北京军区总医院、北京妇产医院、北京市海淀医院产科2010年11月-2011年11月产科住院病人中,纳入发生胎盘早剥的产妇及新生儿作为胎盘早剥观察组(早剥组);非胎盘早剥观察组(非早剥组)为上述单位早剥组每例患者后2名产科入院患者,以办理入院登记时间为准。采集产妇的静脉血及新生儿脐静脉血、脐动脉血,并收集胎盘组织,用ELISA法检测其VWF、ADAMTS13水平。结果早剥组共纳入58例,非早剥组共纳入116例。根据非早剥组检测值计算出单侧95%参考值。产妇静脉血:VWF<857.80 U.L-1,ADAMTS13>119.63 U.L-1;脐静脉血:VWF<852.71 U.L-1,ADAMTS13>28.12 U.L-1;脐动脉血:VWF<1 416.96 U.L-1,ADAMTS13>147.90 U.L-1;胎盘组织VWF<760.66 U.L-1,ADAMTS13>27.53 U.L-1。早剥组各项VWF高于非早剥组(Pa<0.05);早剥组产妇血及脐血ADAMTS13水平均低于非早剥组(Pa<0.05)。结论胎盘早剥孕妇/产妇及胎儿/新生儿体内ADAMTS13水平随VWF水平的升高而下降,VWF是胎盘早剥发生时母儿高凝状态的因素之一,ADAMTS13具有保护作用。
Objective To observe the changes of neonatal umbilical cord blood and maternal venous blood von Willebrand factor (VWF) and von Willebrand factor lyase (ADAMTS13) in placental abruption, and to explore the pathological mechanism of coagulation dysfunction in neonates with placental abruption. Methods The obstetric inpatients of Beijing Military Region General Hospital, Beijing Maternity Hospital and Beijing Haidian Hospital from November 2010 to November 2011 were enrolled in this study. The maternal and neonates with placental abruption were included in the observation group ); Non-placental abruption observation group (non-abruption group) for the above-mentioned unit stripping group of each patient after 2 obstetric patients admitted to hospital for admission time shall prevail. The maternal venous blood and neonatal umbilical vein blood and umbilical artery blood were collected and the placental tissues were collected. The levels of VWF and ADAMTS13 were detected by ELISA. Results A total of 58 cases were enrolled in the stripping group and 116 cases in the non-stripping group. 95% unilateral unilateral reference value calculated according to the test value of non-tearing group. Maternal Venous Blood: VWF <857.80 UL-1, ADAMTS13> 119.63 UL-1; Umbilical Venous Blood: VWF <852.71 UL-1, ADAMTS13> 28.12 UL-1; Umbilical Artery Blood: VWF <1 416.96 UL-1, ADAMTS 13> 147.90 UL-1; placental tissue VWF <760.66 UL-1, ADAMTS13> 27.53 UL-1. The VWF in the early stripping group was significantly higher than that in the non-stripping group (Pa, 0.05). The levels of maternal blood and umbilical cord blood ADAMTS13 in the early stripping group were lower than those in the non-stripping group (Pa0.05). Conclusions The level of ADAMTS13 in pregnant women, fetus and fetus / newborn with placental abruption decreased with the increase of VWF. VWF is one of the factors of hypercoagulability in pregnant women with placental abruption. ADAMTS13 has a protective effect.