妊娠時の血液凝固，線溶系の研究

—正常妊娠およびDICにおけるその変動—

抄録

Physiological changes of coagulation-fibrinolytic system (PT, APTT, Factors I, II, V, VII, VIII, IX, X, XI, XII, SFMC, FDP, tPA antigen, PA activity) during pregnancy, delivery and puerperium, were investigated in 43 healthy non-pregnant (control) and 143 pregnant women. Because of incresed SFMC and coagulation factors (I, II, VII, VIII, IX, X, XII) during pregnancy, pregnant plasma seemed to be hypercoagulable. PA activity did not increase until the first stage of labor (9.1±2.1 IU/ml), while tPA antigen had already increased in the third trimester and reached its peak value (17.7±6.4 ng/ml) immediately after delivery. These results suggest that there is discrepancy between the level of tPA antigen and PA activity during late pregnancy.
Based on these physiological changes, change of coagulation and fibrinolytic system (plg, α₂PI, AT-III, crosslinked FDP, ESR, Plt added to the above factors) were determined in a case of DIC that occurred after abruptio placentae. In this case, stimulation of extrinsic pathway seemed to cause the DIC because of diminished extrinsic coagulation factors. Moreover surprising finding in the present DIC study was that in spite of increased level of tPA antigen (16.4 ng/ml) in peripheral blood plasma, PA activity was significantly decreased (1.8 IU/ml).