Coagulation-related Factors Such As Peripheral Blood D-dimer In Patients With Preeclampsia And Expression Of Placental T-PA And PAI-1

Objective: This experiment detected the level of D-dimer ?the platelet paramerters and coagulation function index to study the blood coagulation function of patients with preeclampsia.And investigated how the fibrinolytic factors of t-PA?PAI-1 represent in placenta.Analyze the correlation between the level of D-D and the adverse prognosis of mother and perinatal infant.Discussed the impact of imbalance of blood coagulation system on PE peripheral blood pathological hypercoagulative state.Provide evidence to help make the decision of termination of pregnancy.Method: 1.116 patients were selected during August 2015 and January 2017 in Jin'an District Hospital in Fuzhou,including 16 late onset severe preeclampsia patients(Group A),20 late onset mild preeclampsia patients(Group B)and 80 normal pregnancy control subjects(Group C).Blood samples were collected every 2 weeks after the 34 th gestational week to measure the levels of PLT?MPV?PDW?PCT?D-D?PT?APTT?TT?FIB,and the results were compared by mean value analysis.2.For all three groups,the maternal age,the gestational weeks at delivery,blood pressure were collected as well as the infant's Apgar score and weight.Those records were analyzed with maternal complications including placental abruption,fetal growth restriction,fetal distress,and post-partum hemorrhage.3.Immunohistochemistry technique were used to study the presence of fibrinolytic factors t-PA?PAI-1 in placenta in normal pregnancy and preeclampsia patients.Results: This study compared the blood platelets density,four coagulation parameters and the fibrinolytic factors of preeclampsia patients and healthy pregnant women during late pregnancy.The results show:1.The PLT in peripheral blood is significantly lower in group A compared to group C.In contrast,MPV and PDW in peripheral blood is significantly higher in group A compared to group B and C.2.PT is markedly higher in group A.FIB value does not show any statistically significant difference in between the three groups(P>0.05).The APTT value in group A and B is higher than group C.Group A also showed a higher TT value(P<0.05).3.D-dimer had a gradient in the three groups with highest value in group A and lowest in group C(P<0.05).4.The t-PA level in the placenta of Preeclampsia patients is lower compared to the control group.On the other hand,PAI-1 in the placenta of group A patients are higher than group B and C(P<0.05).5.Maternal complications are higher in group A compared to group B and C.The D-D level in peripheral blood has a negative correlation with fetal weight.Conclusion :1.Severe preeclampsia patients have decreased blood platelets count.Combining blood platelets count with mean platelet volume and mean platelet distribution width will increase the accuracy of diagnosing preeclampsia patients.2.When the coagulation function is in compensatory state preeclampsia patients might have shortened coagulation time.However,this study showed the coagulation time is actually prolonged,suggesting that the pregnant women with longer duration of pregnancy may have decompensation in blood coagulation.3.The mmunohistochemical detection of t-PA and PAI-1 in placenta confirmed that preeclampsia patients especially severe preeclampsia patients change their coagulation function from compensation to decompensation.The pathological mechanism of preeclampsia was further demonstrated.