血栓弹力图联合凝血指标检测在妊娠子痫前期中的应用价值
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摘要
目的通过分析妊娠高血压子痫前期患者血栓弹力图(TEG)和常规凝血的各项参数,评估各研究指标对妊娠高血压子痫前期血栓前状态的预测价值。方法选择2015年1月-2017年9月来甘肃省妇幼保健院分娩的妊娠子痫前期患者296例作为研究对象,按产科诊断标准分为轻度子痫前期组140例、重度子痫前期组156例,选取同期正常妊娠晚期孕妇300例作为对照组,均在入院后、分娩前抽取肘正中静脉血分别进行血栓弹力图、常规凝血及抗凝血酶Ⅲ(AT-III)、D-二聚体水平检测。结果轻度子痫前期组TEG各项参数与对照组比较差异均无统计学意义(P>0. 05);重度子痫前期组患者的TEG参数与对照组比较除α角外,R值、K值增大,MA值显著缩短,CI值显著减小,差异均有统计学意义(P<0. 05);轻度子痫前期与重度子痫前期组比较TEG各项参数差异均无统计学意义(P>0. 05)。3个组常规凝血象的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fg)、凝血酶时间(TT)、D-二聚体、AT-Ⅲ、血小板(PLT)值分别进行两两比较,轻度子痫前期组与对照组比较APTT差异有统计学意义(P<0. 05),APTT值延长,其余各项指标差异均无统计学意义(P>0. 05);重度子痫前期组与对照组比较PLT及APTT差异有统计学意义(P<0. 05),APTT值延长,PLT减低;重度子痫前期组与轻度子痫前期组比较PLT差异有统计学意义(P<0. 05),PLT减低,其余各项指标差异均无统计学意义(P>0. 05)。结论 TEG检测联合常规凝血及D-二聚体检测能全面反映子痫前期患者的凝血状态,两者联合互补,能快速、有效地判断妊娠期高血压子痫前期妇女凝血状态,如能早期干预可能降低围产期出血及栓塞性疾病发生率。
Objective To analyze the parameters of thrombelastogram( TEG) and blood coagulation in patients with preeclampsia,evaluate the prognostic value of these parameters for prethrombotic state. Methods A total of 296 preeclampsia patients givig birth to their babies in Gansu Provincial Maternal and Child Health Care Hospital from January 2015 to September 2017 were selected and divided into mild preeclampsia group( 140 patients) and severe preeclampsia group( 156 patients) according to obstetric diagnostic criteria; 300 normal late pregnant women during the same period were selected as control group. TEG,conventional blood coagulation detection,antithrombase Ⅲ( AT-III),and D-dimer detection in median cubital vein blood were performed after admission and before delivery. Results There was no statistically significant difference in TEG parameters between mild preeclampsia group and control group( P>0. 05). Compared with control group,excluding α angle,R value and K value in severe preeclampsia group increased,MA value shortened significantly,CI value decreased significantly( P<0. 05). There was no statistically significant difference in TEG parameters between mild preeclampsia group and severe preeclampsia group( P>0. 05). There was statistically significant difference in activated partial thromboplastin time( APTT) between mild preeclampsia group and control group( P<0. 05),but there was no statistically significant difference in prothrombin time( PT),fibrinogen( Fg),thrombin time( TT),D-dimer,AT-Ⅲ,and platelet( PLT) among the three groups( P>0. 05). There were statistically significant differences in PLT and APTT between severe preeclampsia group and control group( P<0. 05),there was statistically significant difference in PLT between severe preeclampsia group and mild preeclampsia group( P < 0. 05),but there was no statistically significant difference in other parameters( P>0. 05). Conclusion TEG combined with blood coagulation indexes and D-dimer detection can comprehensively reflect blood coagulation state of preeclampsia patients,rapidly and effectively predict blood coagulation state,early intervention may reduce the incidence rates of perinatal bleeding and thrombotic diseases.
Objective To analyze the parameters of thrombelastogram( TEG) and blood coagulation in patients with preeclampsia,evaluate the prognostic value of these parameters for prethrombotic state. Methods A total of 296 preeclampsia patients givig birth to their babies in Gansu Provincial Maternal and Child Health Care Hospital from January 2015 to September 2017 were selected and divided into mild preeclampsia group( 140 patients) and severe preeclampsia group( 156 patients) according to obstetric diagnostic criteria; 300 normal late pregnant women during the same period were selected as control group. TEG,conventional blood coagulation detection,antithrombase Ⅲ( AT-III),and D-dimer detection in median cubital vein blood were performed after admission and before delivery. Results There was no statistically significant difference in TEG parameters between mild preeclampsia group and control group( P>0. 05). Compared with control group,excluding α angle,R value and K value in severe preeclampsia group increased,MA value shortened significantly,CI value decreased significantly( P<0. 05). There was no statistically significant difference in TEG parameters between mild preeclampsia group and severe preeclampsia group( P>0. 05). There was statistically significant difference in activated partial thromboplastin time( APTT) between mild preeclampsia group and control group( P<0. 05),but there was no statistically significant difference in prothrombin time( PT),fibrinogen( Fg),thrombin time( TT),D-dimer,AT-Ⅲ,and platelet( PLT) among the three groups( P>0. 05). There were statistically significant differences in PLT and APTT between severe preeclampsia group and control group( P<0. 05),there was statistically significant difference in PLT between severe preeclampsia group and mild preeclampsia group( P < 0. 05),but there was no statistically significant difference in other parameters( P>0. 05). Conclusion TEG combined with blood coagulation indexes and D-dimer detection can comprehensively reflect blood coagulation state of preeclampsia patients,rapidly and effectively predict blood coagulation state,early intervention may reduce the incidence rates of perinatal bleeding and thrombotic diseases.
引文
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[10]Davies JR,Fernando R,Hallworth SP.Hemostatic function in healthy pregnant and preeclamptic women:an assess-ment using the platelet function analyzer(PFA-100)and thrombo-elastograph[J].Anesth Analg,2007,104(2):416-420.
[11]李媛.妊娠高血压患者D-二聚体变化与患者病情程度、预后的关系研究[J].中国现代医生,2015,53(1):80-81.
[12]Halset HJ,Hanssen SW,Espinosa A,etal.Tromboelastography:variability and relation to conventional coagulation test innon-bleeing intensive care unit patients[J].BMC Anesthesiol,2015,15:28.
[13]韩旭东,黄晓英,殷国平,等.血栓弹力图与传统凝血试验评价肝病凝血功能的相关性研究[J].中国交通医学杂志,2010,24(2):162-164.
[14]Agren A,Wikman AT,Holmstrom M,et al.Thromboelastography(TEG)compared toconventional coagulation tests in surgical patients:a laboratory evaluation[J].Scand J Clin Lab Invest,2013,73(3):214-220.
[15]王鸿利.开展血栓与止血实验项目的优化组合和临床应用研究[J].中华血液学杂志,2006,27(9):577-578.
[16]陈冠伊,欧阳锡林,吴靖辉,等,血栓弹力图与常规凝血四项评价临床患者凝血功能的对比研究[J],中国实验血液学杂志,2015,23(2):546-551.
[2]毛雅静,杨祖菁.血栓弹力图在检测重度子痫前期孕妇凝血功能障碍中的意义[M].上海交通大学学报(医学版)2013:1612-1615.
[3]李明辉,时露.血栓和出血性疾病中血栓弹力图与常规凝血功能检测指标的相关性分析[J].现代医药卫生,2016,32(17):2703-2704.
[4]王惠梅.血栓弹力图与常规凝血检查的相关性分析[J].中国现代医药杂志,2018,20(2):80-81.
[5]董林剑,李元海.血栓弹力图的临床应用及发展[J].安徽医药,2015,19(15):817-819.
[6]Wei Wang,Ai-ming Wang,Xin-qiang Huang,Wen Jiang,Xiaoning Jia.Thromboelastography in Women with Pathological Pregnancies:a Preliminary Study[J].Chinese Med Sci J,2014,(1):63-64.
[7]翟宏,续薇.重度子痫前期实验室指标的检测和临床意义[J].中国实验诊断学,2013,17(1):117-118.
[8]马学斌,马骢,杨明,等.TEG血栓弹力图同常规凝血试验的相关性研究[J].国际检验医学杂志,2013,34(24):3335-3336.
[9]贾佳,杨巧妮,赵子房,等.晚期妊娠合并重度子痫前期患者血栓弹力图特点分析[J].中国医科大学学报,2016,45(12):1105-1109.
[10]Davies JR,Fernando R,Hallworth SP.Hemostatic function in healthy pregnant and preeclamptic women:an assess-ment using the platelet function analyzer(PFA-100)and thrombo-elastograph[J].Anesth Analg,2007,104(2):416-420.
[11]李媛.妊娠高血压患者D-二聚体变化与患者病情程度、预后的关系研究[J].中国现代医生,2015,53(1):80-81.
[12]Halset HJ,Hanssen SW,Espinosa A,etal.Tromboelastography:variability and relation to conventional coagulation test innon-bleeing intensive care unit patients[J].BMC Anesthesiol,2015,15:28.
[13]韩旭东,黄晓英,殷国平,等.血栓弹力图与传统凝血试验评价肝病凝血功能的相关性研究[J].中国交通医学杂志,2010,24(2):162-164.
[14]Agren A,Wikman AT,Holmstrom M,et al.Thromboelastography(TEG)compared toconventional coagulation tests in surgical patients:a laboratory evaluation[J].Scand J Clin Lab Invest,2013,73(3):214-220.
[15]王鸿利.开展血栓与止血实验项目的优化组合和临床应用研究[J].中华血液学杂志,2006,27(9):577-578.
[16]陈冠伊,欧阳锡林,吴靖辉,等,血栓弹力图与常规凝血四项评价临床患者凝血功能的对比研究[J],中国实验血液学杂志,2015,23(2):546-551.
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