Association Between Coagulation-fibrinolysis System Correlation Factors And Recurrent Spontaneous Abortion

PART ONE Analysis of the Changes for Related Indicators of the Coagulation-fibrinolysis System in Patients with Spontaneous AbortionObjective:In this study,the correlation between the changes of the coagulation-fi brinolytic system indicators and spontaneous abortion(SA)was explored through the analysis of the test results of the related indicators of the coagulation-fibrinolyss system,thereby providing a certain theoretical reference for the condition evaluation and treatment of spontaneous abortion.Methods:Retrospective analysis and controlled study were used in this study.A total of 345 patients with spontaneous abortion were selected from August 2015 to April 2018 in Zhangjiagang Hospital of Traditional Chinese Medicine and the northern part of Suzhou Municipal Hospital were included in the study group(including Study Group 1 with the number of spontaneous abortion>3,Study Group 2 with the number of spontaneous abortion as 1,and Study Group 3 with the number of spontaneous abortion as 1).In addition,340 healthy women who had voluntarily terminated pregnancy during the same pregnancy week were included in the control group(including Control Group 1 with the number of induced abortion>3,Control Group 2 with the number of induced abortion as 2,and Control Group 3 with the number of induced abortion as 1).Each patient's venous blood was collected in the fasting state.Coagulation-fibrinolysis system function related indicators were detected.All patients did not take anticoagulant drug and medicines that had an influence on the fibrinolytic system prior 2 weeks of the blood collection.Results:There was no significant difference in prothrombin time(PT),antithrombin?(AT ?),platelet blood test(PLT)and activated partial thromboplastin time(APTT)between the study group and the control group.The level of D-dimer was 172.37±8.58 ng/ml in the study group but 109.27±3.36 ng/ml in the control group,so the difference was statistically significant(P<0.01).Among them,There was no significant difference in PT?AT ? PLT?APTT between the study group 1 and the control group 1.The level of D-dimer was 163.57±16.48 ng/ml in the study group 1 but 106.79±5.91 ng/ml in the control group 1,so the difference was statistically significant(P<0.05);There was no significant difference in PT?AT ??PLT?APTT between the study group 2 and the control group 2.The level of D-dimer was 187.72±17.51 ng/ml in the study group 2 but 107.20±5.86 ng/ml in the control group 2,so the difference was statistically significant(P<0.05);There was no significant difference in PT?AT ??PLT?APTT between the study group 3 and the control group 3.The level of D-dimer was 164.43±10.59 ng/ml in the study group 3 but 113.10±5.69 ng/ml in the control group 3,so the difference was statistically significant(P<0.05);Therefore,D-dimer is closely related to the occurrence of spontaneous abortion.D-dimer can be used as a specific marker to reflect the hypercoagulability,secondary increased fibrinolytic activity,and thrombophilia of the body.Conclusion:D-dimer is an important index of the fibrinolytic system.It has a certain predictive value for the diagnosis of spontaneous abortion.The testing of molecular markers in plasma fibrinolytic system is conducive to the early detection of thrombophilia,thereby performing the corresponding treatment,which can effectively prevent thrombosis and reduce complications.PART TWO Correlation between Thrombophilia Markers TM,EPCR,TAFI and Recurrent Spontaneous AbortionObjective:The correlation between the coagulation-fibrinolysis system and recurrent spontaneous abortion(RSA)has attracted much attention.Based on the first part of the research work,the changes in the related indicators of the coagulation system in peripheral vein blood of women with RSA and women who voluntarily terminated pregnancy during the same pregnancy week were detected,as well as the levels of soluble thrombomodulin(sTM),soluble endothelial protein C receptor(sEPCR)and thrombin-activatable fibrinolysis inhibitor(TAFI)in peripheral vein blood of two groups of patients.Therefore,the correlation with the recurrent pregnancy loss and the expression of TM and EPCR in the chorionic villus of patients with RSA can be understood,in order to provide a theoretical reference for exploration of the etiological prevention of RS A and the guidance in the early clinical anticoagulant therapy,reduce the occurrence of RSA,improve the adverse pregnancy outcome,and effectively guide the clinical work.Methods:With a method of the case-control study 25 patients with RSA(the number of previous spontaneous abortions ?2)were included in the study group,and 26 patients with voluntary termination of pregnancy in the same period under the condition of early healthy pregnancy were included in the control group.The coagulation-fibrinolysis system related indicators were firstly compared.Then,the contents of the plasma sTM,sEPCRand TAFI were detected to further detect the expression of TM and EPCR genes in the villus tissue.Results:(1)There was no significant difference in plasma TAFI indicator between the control group and the study group(P>0.05).(2)The level of D-dimer was increased in the study group,and the difference was statistically significant(P<0.05).(3)The content of STM and SEPCR in plasma of the study group was significantly higher than that in the control group(P<0.05).(4)The expression of TM mRNA and EPCR mRNA in chorionic villus of the study group was lower than that in the control group(P<0.05).Conclusion:TAFI is not a direct risk factor for RSA.D-dimer can be used as a screening index for the diagnosis of thrombophilia in patients with RSA.The thrombophilia markers TM,EPCR and RSA are closely related to each other.The results of the study can provide theoretical guidance for better prevention of the occurrence of spontaneous abortion.Levels of sTM and sEPCR in plasma is of great significance for evaluating the clinical risk of successful pregnancy in women with RSA.