子宫腺肌病患者凝血功能的变化  

Changes of coagulation function in patients with adenomyosis

作　　者：张会媛 王安琪 朱姝 虞梁 孙佳凡 徐炜 王秀丽 Zhang Huiyuan;Wang Anqi;Zhu Shu;Yu Liang;Sun Jiafan;Xu Wei;Wang Xiuli(Department of Obstetrics and Gynecology,the First Clinical School of Medicine,Nanjing Medical University,Nanjing 210029,China;Department of Gynecology,Jiangsu Province Hospital,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210036,China)

机构地区：[1]南京医科大学第一临床医学院妇产科学系,南京210029 [2]南京医科大学第一附属医院江苏省人民医院妇科,南京210036

出　　处：《中华妇产科杂志》2022年第3期179-189,共11页Chinese Journal of Obstetrics and Gynecology

基　　金：江苏省卫健委科研课题(H2018017);江苏省妇幼健康重点人才课题(RC201709)。

摘　　要：目的:探讨子宫腺肌病患者凝血功能的变化及其临床意义。方法:(1)回顾性分析2017年1月至2021年12月在南京医科大学第一附属医院就诊的25例健康妇女和25例子宫腺肌病患者,分析其经期和非经期凝血指标的变化情况。(2)分析同期在本院住院行子宫切除术的子宫腺肌病患者145例(非出血期观察组)和子宫颈上皮内瘤变Ⅲ级患者129例(非出血期对照组),比较两组患者术前的凝血指标。(3)分析同期在子宫出血期于本院门诊行诊刮术的子宫腺肌病患者154例(出血期观察组)和经妇科超声检查子宫肌层无病变的妇女147例(出血期对照组),比较两组在子宫出血期的凝血指标。(4)分析子宫腺肌病患者凝血指标与癌相关抗原125(CA 125)、癌相关抗原19-9(CA 19-9)、子宫体积的相关性。结果:(1)25例健康妇女的凝血指标在经期和非经期间无显著差异(P均>0.05);子宫腺肌病患者经期纤维蛋白原[FIB;2.61 g/L(2.50~3.10 g/L)]和D-二聚体[0.60 mg/L(0.40~1.00 mg/L)]均明显高于非经期[FIB为2.25 g/L(1.90~2.70 g/L)、D-二聚体为0.27 mg/L(0.20~0.40 mg/L);P均<0.01],经期凝血酶时间[TT;16.70 s(16.10~17.40 s)]明显低于非经期[17.95 s(17.20~18.40 s);P<0.01)]。(2)与非出血期对照组相比,非出血期观察组子宫腺肌病患者的D-二聚体[0.26 mg/L(0.20~0.40 mg/L)]、血小板计数[257.0×109/L(212.0×109/L~308.5×109/L)]均增高(P均<0.01)。其中,FIB(r=0.237,P=0.004)和D-二聚体(r=0.373,P<0.001)均与CA 125呈正相关,凝血酶原时间(PT;r=-0.208,P=0.012)和凝血酶原时间国际标准化比值(PT-INR;r=-0.201,P=0.015)均与CA 19-9呈负相关。(3)与出血期对照组相比,出血期观察组子宫腺肌病患者的PT[10.70 s(10.10~11.20 s)]、PT-INR[0.93(0.90~1.00)]均减小,D-二聚体[0.41 mg/L(0.20~0.80 mg/L)]升高(P均<0.01)。其中,FIB(r=0.252,P=0.038)、D-二聚体(r=0.321,P=0.008)均与子宫体积呈正相关,活化部分凝血活酶时间(APTT;r=-0.190,P=0.018)和TT(r=-0.304,P=0Objective To explore the different coagulation state in patients with adenomyosis and its clinical significance.Methods Clinical data of the patients admitted to the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2021 were retrospectively analyzed.(1)Differential coagulation state between 25 healthy women and 25 patients with adenomyosis were compared during menstrual and non-menstrual periods.(2)The coagulation indexes of 145 patients with adenomyosis(observation group 1)and 129 patients with cervical intraepithelial neoplasia gradeⅢ(control group 1)who underwent hysterectomy in non-menstrual period were compared.(3)The coagulation indexes of 154 patients with adenomyosis(observation group 2)and 147 women without myometrial lesions(control group 2)who underwent endometrial curettage during uterine bleeding period were compared.(4)Correlations of coagulation index with cancer antigen 125(CA125),cancer antigen 19-9(CA19-9)and uterine volume in patients with adenomyosis were analyzed.Results(1)The coagulation state of each health women during the menstrual and non-menstrual period showed no significant differences(all P>0.05).For the 25 patients with adenomyosis,fibrinogen[FIB;2.61 g/L(2.50-3.10 g/L)]and D-dimer[0.60 mg/L(0.40-1.00 mg/L)]in the menstrual period were significantly higher than those in the non-menstrual period[2.25 g/L(1.90-2.70 g/L)and 0.27 mg/L(0.20-0.40 mg/L),respectively;both P<0.01],while thrombin time[TT;16.70 s(16.10-17.40 s)]in the menstrual period was significantly lower than that in the non-menstrual period[17.95 s(17.20-18.40 s);P<0.01].(2)In the non-bleeding period,D-dimer[0.26 mg/L(0.20-0.40 mg/L)]and platelet count[257.0×109/L(212.0×109/L-308.5×109/L)]of observation group 1 were significantly higher than those of control group 1(all P<0.01).Besides,FIB(r=0.237,P=0.004)and D-dimer(r=0.373,P<0.001)were positively correlated with CA125,while prothrombin time(PT;r=-0.208,P=0.012)and internationalized normalized ratio of plasma prothrombin time(PT-

关 键 词：子宫腺肌病 血栓形成倾向 CA-125抗原 凝血酶原时间 部分促凝血酶原时间 贫血 

分 类 号：R711.71[医药卫生—妇产科学]