凝血指标联合血栓弹力图预测妊娠期血小板减少症孕妇分娩结局  

Prediction of the coagulation parameters values combined with the elastography of pregnant women with gestational thrombocytopenia for their delivery outcomes

作　　者：向黎明 刘淑梅 周扬 袁长勇 XIANG Liming;LIU Shumei;ZHOU Yang;YUAN Changyong(Shandong Second Medical University,Weifang,Shandong Province,261053;Dezhou Hospital,Qilu Hospital of Shandong University,Dezhou,Shandong Province)

机构地区：[1]山东第二医科大学,潍坊261053 [2]山东大学齐鲁医院德州医院

出　　处：《中国计划生育学杂志》2024年第7期1673-1676,共4页Chinese Journal of Family Planning

基　　金：山东省医学会临床科研资金专项(YXH2022ZX03231);国家科学技术委员会(2014WS0431)。

摘　　要：目的:探究凝血指标、弹力图(TEG)在妊娠期血小板减少症(GT)孕妇中的变化及对分娩结局的预测价值。方法:收集本院2020年1月-2023年12月分娩孕妇110例临床资料,根据血小板计数(PLT)判定GT发生情况,分为GT组(PLT<100×10^(9)/L,n=58),52例分入正常组(PLT≥100×10^(9)/L,n=52)。对比两组凝血指标与TEG参数,Spearman相关系数分析凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、TEG参数与GT发生率的相关性。根据GT组分娩结局情况分为不良分娩组、健康分娩组并对比两组凝血指标、TEG参数;绘制受试者工作特征(ROC)曲线分析凝血指标、TEG参数诊断GT孕妇分娩结局的临床价值。结果:GT组与正常组PT、APTT、TT和FIB水平无差异(P>0.05),GT组血凝块形成速度(Angle)、血凝块最大振幅(MA)、凝血综合指数(CI)均均低于正常组;GT发生率与PT、APTT、TT、FIB与无相关性,GT发生率与Angle、MA、CI均呈负相关(均P<0.05)。不良分娩组与健康分娩组PT、APTT、TT和FIB水平无差异(P>0.05),不良分娩组Angle、MA、CI均低于健康分娩组(P<0.05)。凝血指标与TEG参数联合诊断GT孕妇分娩结局的曲线下面积为0.916、敏感度92.3%、特异度93.8%,均高于单独指标诊断(均P<0.05)。结论:GT孕妇常规凝血指标未出现明显变化,说明GT对凝血功能指标影响不明显;而TEG参数异常降低。凝血指标联合TEG参数预测GT孕妇分娩结局效能较高。Objective:To investigate the values changes of the coagulation parameters combined with the elastography(TEG) of pregnant women with gestational thrombocytopenia(GT),and to study their predictive value for the delivery outcomes of the women.Methods:The clinical data of 110 pregnant women who had delivered in the hospital from January 2020 to December 2023 were collected in this study.The occurrence of the GT of the women was determined according to their platelet count(PLT),and these were women divided into group A(58 women with GT and the PLT value <100×10^(9)/L) and group B(52 women without GT and the PLT value ≥100×10^(9)/L).The values of the coagulation indexes and TEG parameters of the women were compared between the two groups.Spearman correlation coefficient was used to analyze the correlation between the levels of the prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),fibrinogen(FIB) and the TEG parameters of the women and the incidence of their GT.The women in group A were divided into group A1(women with the normal delivery outcomes) and group A2(women with the poor delivery outcomes),and the values of the coagulation indexes and TEG parameters of the women were compared between the two groups.ROC curve was drawn to analyze the clinical values of the coagulation indexes and TEG parameters values of the women with GT in group A for diagnosing their delivery outcomes.Results:There were no significantly differences in the PT,APTT,TT and FIB levels of the women were compared between the group A and group B(P>0.05).The blood clot formation rate(Angle),the maximum amplitude of blood clots(MA) and the coagulation index(CI) value of the women in group A were all significantly lower than those of the women in group B.The incidence of GT of the women was no correlated with their PT,APTT,TT and FIB levels,while which was negatively correlated with their Angle,MA and CI value(all P<0.05).There were no significant differences in the PT,APTT,TT and FIB levels of the women between g

关 键 词：妊娠期血小板减少症 凝血指标 血栓弹力图 分娩结局 预测价值 

分 类 号：R714.254[医药卫生—妇产科学]