凝血、血小板及生化指标对重度子痫前期的辅助诊断价值研究  

The Value of Coagulation,Platelet and Biochemical Indicators in Assistant Diagnosis of Severe Preeclampsia

作　　者：方章华 秦田瑞 邓晨晨[1] 陶峰[1] 陈红波[1] FANG Zhanghua;QIN Tianrui;DENG Chenchen(Department of Obstetrics and Gynecology,Maternal and Child Health Hospital Affiliated to Anhui Medical University,Hefei Anhui 230001,China)

机构地区：[1]安徽医科大学附属妇幼保健院妇产科,安徽合肥230001

出　　处：《实用妇产科杂志》2020年第12期936-940,共5页Journal of Practical Obstetrics and Gynecology

基　　金：安徽省中央引导地方科技发展科技创新项目示范类项目(编号:201707d08050003);安徽省临床重点专科建设项目(编号:201730)。

摘　　要：目的:探讨凝血、血小板、生化参数在辅助诊断子痫前期严重程度中的价值。方法:选择2015年1月至2016年6月在安徽医科大学附属妇幼保健院分娩的283例产妇为研究对象,其中子痫前期组142例、重度子痫前期组141例。收集两组孕妇年龄、分娩孕周、体质量指数、血压等资料,检测两组孕妇血常规、凝血指标、生化指标,比较两组孕妇上述指标的差异。采用Logistic回归分析重度子痫前期的独立影响指标,并采用受试者工作特征(ROC)曲线下面积(AUC)分析血小板计数(PLT)、钙(Ca)、尿酸(UA)、胆固醇(Chol)对子痫前期严重程度的辅助诊断价值。结果:两组孕妇D-二聚体(D-D)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、国际标准化比值(INR)、血红蛋白(Hb)、血细胞比容(Hct)差异均无统计学意义(P>0.05),重度子痫前期组PLT低于子痫前期组,差异有统计学意义(P<0.05)。重度子痫前期组中Ca、白蛋白(Alb)低于子痫前期组,肌酐(Cr)、尿素氮(BUN)、UA、乳酸脱氢酶(LDH)、Chol高于子痫前期组,差异有统计学意义(P<0.05);两组直接胆红素(DBil)、间接胆红素(IBil)、球蛋白(Glb)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、甘油三酯(TG)差异无统计学意义(P>0.05)。多因素Logistic回归模型分析显示低PLT、低Ca、高UA、高Chol是重度子痫前期的独立影响因素(P<0.05)。UA、Chol、PLT、Ca辅助诊断重度子痫前期的AUC分别为0.627、0.641、0.411、0.377,UA、Chol、PLT、Ca 4个指标联合诊断时AUC最高为0.734。结论:UA、Chol、PLT、Ca是子痫前期病情严重程度的独立危险因素,可作为辅助诊断子痫前期严重程度的指标,联合4个指标的诊断价值较大,但其特异性和敏感性仍不理想,需要进一步研究寻找有效的辅助诊断指标。Objective:To investigate the value of coagulation function,platelet and biochemical indicators in the diagnosis of severe preeclampsia.Methods:A total of 283 pregnant women who delivered in the Maternal and Child Health Hospital affiliated Anhui Medical University from January 2015 to June 2016 were selected,including 142 cases in the preeclampsia group and 141 cases in the severe preeclampsia group.The baseline characteristics such as age,delivery weeks,BMI,blood pressure and the laboratory parameters of blood routine,coagulation,biochemical indicators of two groups were compared.The Logistic regression method was used to analyze the independent influence index of severe preeclampsia,and the ROC curve was used to analyze the assistant diagnostic value of platelet count,serum calcium,uric acid,and cholesterol for severe preeclampsia.Results:There were no significant differences in D-D,PT,APTT,TT,Fib,INR,Hb or HCT between the two groups(P>0.05).The PLT count in the severe preeclampsia group was lower than that in the preeclampsia group(P<0.05).The Ca and Alb level of severe preeclampsia group were significantly lower than that in the preeclampsia group;Cr,BUN,UA,LDH,and Chol level were higher than that in the preeclampsia group(P<0.05).There was no significant difference in DBil,IBil,Glb,ALT,AST or TG level(P>0.05).The multivariate logistic regression analysis showed that low platelet,low calcium,high uric acid and high cholesterol were independent factors associated with severe preeclampsia(P<0.05).The results of ROC curve analysis showed that the AUC of UA,Chol,PLT,Ca were 0.627,0.641,0.411,0.377,respectively.Combined detection of UA,Chol,PLT,Ca showed the highest auxiliary diagnostic value for the severe preeclampsia(AUC=0.734,P<0.05).Conclusions:UA,Chol,PLT and Ca are independent risk factors for severe preeclampsia.They may have auxiliary diagnostic value for severity.Combining four indicators showed the greatest diagnostic value.

关 键 词：子痫前期 血小板 胆固醇 尿酸 受试者工作特征曲线 

分 类 号：R714.25[医药卫生—妇产科学]