The response to activated protein C (APC) was investigated in 28 healthy women, non-carriers of the Arg506-Gln mutation in factor V, throughout pregnancy (gestation weeks 12, 20, 28, 32 and 37) and after the delivery. A suppression of APC response was observed which reached lowest values by week 28 (nAPC-ratio 0.78 +/- 0.13), sustained low up to the end of pregnancy and rose after delivery (1.11 +/- 0.22; P < 0.05). APC resistance (nAPC ratio < 0.75) was registered in 16 of the 28 women (57%). A reduction of APC ratio was directly related to its value in the non-pregnant state, being most pronounced in the women with the highest APC ratio. Factor VIII increased during pregnancy and correlated inversely to APC ratio (Z coefficient = -0.645, P < 0.0001). The correlation became weaker in the course of pregnancy, losing significance by week 32. This was explained by the differences in profiles of the two variablesthe lowest measured APC ratio preceded the peak of factor VIII in most cases. The most pronounced rise of factor VIII was found in the women with minimal levels of APC ratio between 0.8 and 0.7. These results allowed us to speculate that APC response is closely regulated during pregnancy, aiming to maintain a certain relevant level. Transitory reduction of APC response is connected to factor VIII and discussed as a prevalent mechanism of functional APC resistance during pregnancy.

译文

在整个妊娠期间 (妊娠第12、20、28、32和37周) 和分娩后,对28名健康妇女 (非因子V Arg506-Gln突变携带者) 的活化蛋白C (APC) 的反应进行了研究。观察到APC反应的抑制,其在第28周达到最低值 (nAPC比0.78 +/- 0.13),持续到妊娠结束并在分娩后上升 (1.11 +/- 0.22; P <0.05)。28名女性中有16名 (57% 名) 出现APC耐药 (nAPC比值 <0.75)。APC比率的降低与其在非怀孕状态下的价值直接相关,在APC比率最高的女性中最为明显。因子VIII在怀孕期间增加,并与APC比率成反比 (Z系数 = -0.645,P <0.0001)。相关性在怀孕过程中变弱,到第32周失去意义。这可以通过两个变量的分布差异来解释,在大多数情况下,最低的APC比率先于因子VIII的峰值。在0.8和0.7之间APC比率最低的女性中发现了因子VIII的最明显升高。这些结果使我们能够推测APC反应在怀孕期间受到密切调节,旨在维持一定的相关水平。APC反应的暂时性降低与因子VIII有关,并被认为是怀孕期间功能性APC抵抗的普遍机制。

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