反复妊娠丢失妇女未孕及孕早期凝血指标与妊娠结局的关联性分析  

Correlation analysis of coagulation during the non-pregnant and early pregnancy periods and pregnancy outcomes in women with recurrent pregnancy loss

作　　者：赵梦妮 杨凤娜 王芳[2] Zhao Mengni;Yang Fengna;Wang Fang(The Second Clinical Medical School,Lanzhou University,Lanzhou 730030,China;Reproductive Medicine Center,The Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二临床医学院,甘肃兰州730030 [2]兰州大学第二医院生殖中心,甘肃兰州730030

出　　处：《兰州大学学报（医学版）》2023年第12期63-68,75,共7页Journal of Lanzhou University（Medical Sciences）

基　　金：国家自然科学基金资助项目(81960515);中国反复妊娠丢失临床诊断标准的建立多中心研究资助项目(071100132)。

摘　　要：目的 探讨反复妊娠丢失(RPL)妇女未孕及早孕期凝血指标与妊娠结局的关联。方法 回顾性纳入2019年9月—2022年8月就诊于兰州大学第二医院生殖中心的433例RPL患者,根据就诊时是否妊娠分为未孕组(253例)及早孕组(138例),未孕组根据下次妊娠结局是否活产分组,早孕组根据本次妊娠结局是否活产分组。收集患者初次就诊时血清凝血酶原时间、国际标准化比值、部分活化凝血活酶时间(APTT)、血浆纤维蛋白原、凝血酶时间、抗凝血酶Ⅲ、D-二聚体、纤维蛋白(原)降解产物等参数。使用t检验、Logistic回归分析凝血指标与妊娠结局的关联。结果 在未孕RPL人群中,流产组APTT水平较活产组低,差异有统计学意义(P<0.05);未孕RPL人群APTT与流产呈负相关关系(OR=0.944,95%CI:[0.896,0.994],P<0.05);早孕期RPL人群流产组APTT水平较活产组低,差异有统计学意义(P<0.05);早孕期RPL人群APTT与流产呈负相关关系(OR=0.922,95%CI:[0.854,0.995],P<0.05)。结论 RPL患者未孕、早孕期凝血指标与妊娠结局相关,APTT水平降低是RPL的独立危险因素,并可用于常规监测RPL患者,指导临床抗凝干预,以期改善妊娠结局。Objective To explore the association between coagulation during the non-pregnant and early pregnancy periods and pregnancy outcomes in women with recurrent pregnancy loss(RPL).Methods 433 RPL patients who visited the Reproductive Center of the Second Hospital of Lanzhou University between Septem-ber 2019 and August 2022 were retrospectively included and categorized into non-pregnant(253 cases)and early pregnant(138 cases)groups based on their pregnancy status at the time of consultation.The non-preg-nant group was further divided based on the subsequent pregnancy outcome(live birth or miscarriage),while the early pregnant group categorized based on the current pregnancy outcome.Serum parameters including prothrombin time,international normalized ratio(INR),activated partial thromboplastin time(APTT),fibrin-ogen,thrombin time,antithrombinⅢ,D-dimer and fibrin/fibrinogen degradation products were collected at the initial visit.The association between coagulation markers and pregnancy outcomes was analyzed using t-tests and logistic regression.Results In the non-pregnant RPL group,APTT levels were significantly lower in the miscarriage group than the live birth group(P<0.05);A negative correlation was observed between APTT and miscarriage in the non-pregnant RPL group(OR=0.944,95%CI:[0.896,0.994],P<0.05).In the early pregnant RPL group,APTT levels were significantly lower in the miscarriage group than the live birth group(P<0.05).A negative correlation was found between APTT and miscarriage in the early pregnant RPL group(OR=0.922,95%CI:[0.854,0.995],P<0.05).Conclusion Coagulation during the non-pregnant and early pregnancy periods were associated with pregnancy outcomes in women with RPL.Decreased APTT levels independently contributed to the risk of miscarriage and could serve as a routine monitoring parameter in RPL patients,thus serving to guide clinical anticoagulant interventions to improve pregnancy outcomes.

关 键 词：部分活化凝血活酶时间 凝血功能 反复妊娠丢失 D-二聚体 妊娠结局 LOGISTIC回归模型 

分 类 号：R714.21[医药卫生—妇产科学]