HELLP综合征患者凝血功能和血浆血管性血友病因子抗原的变化及意义  

Change and significance of coagulation function and von Willebrand factor antigen level in HELLP syndrome

作　　者：褚翔南 王伟[2] 张贺平[1] 冯庆国[3] 彭云香[1] Chu Xiangnan;Wang Wei;Zhang Heping;Feng Qingguo;Peng Yunxiang(Department of Laboratory,the Fifth Center Hospital in Tianjin,Tianjin 300450,China;Department of ICU,TEDA International Cardiovascular Hospital,Tianjin 300457,China;Department of Critical Care Medicine,the Fifth Center Hospital in Tianjin,Tianjin 300450,China)

机构地区：[1]天津市第五中心医院检验科,天津300450 [2]泰达国际心血管病医院ICU,天津300457 [3]天津市第五中心医院重症医学科,天津300450

出　　处：《中华危重病急救医学》2020年第9期1121-1124,共4页Chinese Critical Care Medicine

基　　金：天津市滨海新区医药卫生科技项目(2016BWKY011)。

摘　　要：目的探讨HELLP综合征(溶血、肝酶升高、血小板减少)患者凝血功能及血管性血友病因子抗原(vWF:Ag)的变化及临床意义.方法回顾性分析天津市第五中心医院重症医学科2015年5月至2019年12月收治的重度子痫前期合并HELLP综合征患者(观察组)的凝血资料,并以同期正常妊娠晚期女性作为对照组.比较两组间凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、抗凝血酶(AT)、纤维蛋白原(Fib)、D-二聚体等凝血指标及血浆vWF:Ag水平的差异,以及不同病情程度HELLP综合征患者之间各指标的差异.结果①纳入HELLP综合征患者65例,正常妊娠晚期者65例,两组均为育龄期妇女,基线资料差异无统计学意义,具有可比性.②两组Fib、D-二聚体水平均升高,但观察组Fib、D-二聚体水平较对照组明显升高〔Fib(g/L):4.94(4.76,5.85)比3.58(2.97,4.14),D-二聚体(mg/L):3.34(2.55,4.32)比1.72(1.29,2.08),均P<0.05〕,AT较对照组明显减低〔62.00(49.00,73.00)%比97.50(90.75,107.00)%,P<0.01〕,而两组PT、APTT均在正常参考值范围.此外,观察组血浆vWF:Ag水平显著高于对照组〔516.50(467.20,563.00)%比246.45(189.95,274.10)%,P<0.01〕.③依据血小板减少情况,65例HELLP综合征患者中轻度〔血小板计数(PLT)>100×109/L〕26例,中度〔PLT(50~100)×109/L〕22例,重度(PLT<50×109/L)17例.随着病情程度加重,轻、中、重度患者D-二聚体、Fib、vWF:Ag水平均显著升高,AT均显著下降,两两比较差异均有统计学意义〔D-二聚体(mg/L):2.63(2.60,2.73)、3.15(2.55,3.73)、3.84(3.52,4.23),Fib(g/L):4.23(4.06,4.47)、4.72(4.34,5.04)、5.43(5.14,5.76),vWF:Ag:465.20(437.20,495.40)%、500.10(472.40,534.50)%、543.50(521.30,563.00)%,AT:67.50(61.60,78.00)%、63.70(53.30,70.40)%、54.40(44.00,61.20)%,均P<0.05〕.结论HELLP综合征患者表现为高凝状态,外周血vWF:Ag水平过度表达,从而诱导血小板聚集,导致血小板减少,发生血栓性微血管病,应引起临床医生重视.Objective To investigate the changes and clinical significance of blood coagulation function and von Willebrand factor antigen(vWF:Ag)in patients with HELLP syndrome(hemolysis,elevated liver function,low platelet count).Methods The clotting data of patients with severe preeclampsia and HELLP syndrome(observation group)admitted to the department of critical care medicine of the Fifth Center Hospital in Tianjin from May 2015 to December 2019 were retrospectively analyzed,and normal late pregnancy women with the same period were enrolled as the control group.The coagulation indexes such as prothrombin time(PT),activated partial thrombin time(APTT),antithrombin(AT),fibrinogen(Fib),D-dimer and plasma vWF:Ag level were compared between the two groups,and among patients with HELLP syndrome with different disease degree.Results①Sixty-five patients with HELLP syndrome and 65 normal pregnant women with third trimester were included.Both groups were women of childbearing age,and there were no significant difference in the baseline data.②The levels of Fib,D-dimer in both groups increased,but they were significantly higher in the observation group than those in the control group[Fib(g/L):4.94(4.76,5.85)vs.3.58(2.97,4.14),D-dimer(mg/L):3.34(2.55,4.32)vs.1.72(1.29,2.08),both P<0.05],the AT was obviously reduced[62.00(49.00,73.00)%vs.97.50(90.75,107.00)%,P<0.01],and both PT and APTT were in the normal reference range in the two groups.In addition,the plasma vWF:Ag level in the observation group was significantly higher than that in the control group[516.50(467.20,563.00)%vs.246.45(189.95,274.10)%,P<0.01].③According to thrombocytopenia,among the 65 patients with HELLP syndrome,26 cases were mild[platelet count(PLT)>100×109/L],22 cases were moderate[PLT(50-100)×109/L],and 17 cases were severe(PLT<50×109/L).With the aggravation of the disease,the D-dimer,Fib,vWF:Ag levels in the mild,moderate,severe patients significantly increased,while the AT level significantly decreased,and there was statistically significant differenc

关 键 词：HELLP综合征 凝血 血管性血友病因子抗原 

分 类 号：R714.244[医药卫生—妇产科学]