血栓弹力图与妊娠期高血压疾病进程及凝血功能的相关性及对产后出血的评估价值  

Correlation of thromboelastography with disease progression and coagulation function of hypertensive disorders of pregnancy and its evaluation value for postpartum hemorrhage

作　　者：聂晶[1] 张文婷 NIE Jing;ZHANG Wenting(Clinical Laboratory,The People's Hospital of Jiyuan City,Henan 459000,China)

机构地区：[1]河南省济源市人民医院检验科,459000

出　　处：《淮海医药》2025年第1期18-22,共5页Journal of Huaihai Medicine

摘　　要：目的:探讨血栓弹力图与妊娠期高血压疾病(HDP)进程、凝血功能的相关性及对产后出血的评估价值,以期为临床早期干预提供参考。方法:回顾性选取某院2020年4月—2022年10月收治的99例HDP患者为研究组,其中妊娠高血压组(38例)、轻度子痫前期组(29例)、重度子痫前期组(32例),产后24 h出血组(21例)、未出血组(78例),另选取99例同期正常妊娠者作为对照组。比较各组间入院时血栓弹力图指标[血凝块形成时间(K值)、凝血反应时间(R值)、凝固角(α角)、血栓最大振幅(MA值)]、凝血四项指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、凝血酶时间(TT)],Spearman/Pearson系数分析入院时血栓弹力图与凝血四项及疾病严重程度的相关性,ROC曲线分析入院时血栓弹力图指标联合检测对HDP患者产后出血的预测价值。结果:R、K值比较:对照组>妊娠高血压组>轻度子痫前期组>重度子痫前期组,MA值、α角比较:对照组<妊娠高血压组<轻度子痫前期组<重度子痫前期组,差异均有统计学意义(P<0.05);PT、APTT、TT水平比较:对照组>妊娠高血压组>轻度子痫前期组>重度子痫前期组,FIB水平比较:对照组<妊娠高血压组<轻度子痫前期组<重度子痫前期组,差异均有统计学意义(P<0.05)。相关性分析显示,入院时R、K值与PT、APTT、TT呈正相关(r=0.498、0.531、0.615;0.433、0.507、0.728,P均<0.05),与FIB、疾病严重程度呈负相关(r=-0.482、-0.631;-0.631、-0.582,P均<0.05);入院时MA值、α角与PT、APTT、TT呈负相关(r=-0.629、-0.493、-0.534;-0.584、-0.622、-0.657,P均<0.05),与FIB、疾病严重程度呈正相关(r=0.704、0.683;0.596、0.716,P均<0.05)。出血组患者R、K值小于未出血组,MA值、α角大于未出血组,差异均有统计学意义(P<0.05)。入院时血栓弹力图指标联合预测HDP患者产后出血的AUC为0.804,敏感度为95.24%、特异度为65.38%。结论:血栓弹力图�Objective:To explore the correlation of thromboelastography with disease progression and coagulation function of hypertensive disorders of pregnancy(HDP),as well as its value in evaluating postpartum hemorrhage,so as to provide reference for early clinical intervention.Methods:A retrospective study was conducted on 99 patients with HDP admitted to a hospital from April 2020 to October 2022,including those with pregnancy-induced hypertension(38 cases),mild preeclampsia(29 cases),and severe preeclampsia(32 cases).They were divided into a hemorrhagic group(21 cases)and non-hemorrhagic group(78 cases)according to whether bleeding occurred within 24 hours after delivery.In addition,another 99 normal pregnant women in the same period were selected as a control group.The thromboelastography indicators[blood clot formation time(K value),clotting reaction time(R value),coagulation angle(αangle),maximum amplitude of thrombus(MA value)]and four coagulation indicators[activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(FIB),thrombin time(TT)]were compared between the two groups of subjects upon admission.Spearman/Pearson correlation analysis was used to analyze the correlation of thromboelastography with the four coagulation indicators and disease severity at admission,and ROC curve analysis was used to evaluate the predictive value of combined detection of thromboelastography indicators for postpartum hemorrhage in HDP patients.Results:Comparison of R and K values between the two groups:the control group>the pregnancy-induced hypertension group>the mild preeclampsia group>the severe preeclampsia group;MA value andαangle comparison:the control group<the pregnancy-induced hypertension group<the mild preeclampsia group<the severe preeclampsia group,with statistically significant differences(P<0.05).Comparison of PT,APTT and TT levels between the two groups:the control group>the pregnancy-induced hypertension group>the mild preeclampsia group>the severe preeclampsia group.Comparison of FIB level:the co

关 键 词：妊娠期高血压 血栓弹力图 凝血功能 疾病进程 产后出血 

分 类 号：R714.24[医药卫生—妇产科学]