蛋白Z与不良妊娠结局的研究进展

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4. 5　PZ缺乏与多种不良妊娠结局　Paidas等[20 ]研究发现51例多种不良妊娠结局(6例胎儿宫内发育迟缓IUGR、26例先兆子痫、21例早产等)的患者血浆PZ水平显著性低于正常妊娠者。PZ水平低于1. 3 mg/L的患者不良妊娠结局的危险性增加4. 25倍。在合并有其它易栓倾向的患者中,不良妊娠结局者比正常妊娠者血浆PZ水平有降低的趋势。Papaioannou等最近的1项前瞻性病例对照研究,评价妊娠合并症孕妇中PZ缺乏的流行特点。PZ缺乏的判断标准是血浆浓度低于1 mg/L。所有的病例均进行遗传性或获得性易栓症检查(如PC、PS、因子V Lei2den突变、凝血酶原20210A等位基因、高同型半胱氨酸血症、甲基四羟叶酸还原酶C6677T突变和抗心磷脂抗体检测) 。总共168例孕妇,其中36例不明原因早期流产, 119例反复流产, 12例宫内死胎和1例胎儿宫内发育迟缓。有46. 5% (78例)患者PZ水平低。23%的PZ水平低的患者无其它易栓症缺陷。因子V Leiden突变,在PZ水平低的患者中有15. 4%, PZ水平正常的患者中有13. 3%。在妊娠合并症,尤其是反复流产的患者中PZ水平低有高的流行性。如果PZ水平低合并有其它易栓缺陷者,妊娠合并症发病的危险性会进一步增加。

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