妊娠期血栓前状态不良妊娠结局的影响因素及血栓弹力图应用价值分析  

Analysis of Factors for Adverse Pregnancy Outcomes in Prethrombotic State Pregnancies and the Clinical Value of Thromboelastography

作　　者：顾鸿旭 米春梅[1] 李慧静 陈姝丹 GU Hongxu;MI Chunmei;LI Huijing(Department of Obstetrics,Xiangya Third Hospital,Central South University,Changsha Hunan 410013,China)

机构地区：[1]中南大学湘雅三医院产科,湖南长沙410013

出　　处：《实用妇产科杂志》2025年第4期331-335,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨妊娠期血栓前状态(PTS)患者不良妊娠结局的影响因素及血栓弹力图(TEG)的应用价值。方法:选择2020年1月至2023年9月就诊于中南大学湘雅三医院产科的183例妊娠期PTS孕妇,根据有无不良妊娠结局,分为良好妊娠结局组(97例)和不良结局组(86例)。通过单因素和多因素分析影响不良妊娠结局的危险因素,并利用受试者工作特征(ROC)曲线和Kaplan-Meier法评估TEG的诊断价值。结果:单因素分析结果示,与良好妊娠结局组比较,抗核抗体(ANA)、抗心磷脂抗体(ACA)、抗β2糖蛋白抗体1(β2-GP1)阳性率在不良妊娠结局组中更高(P<0.05),羟氯喹、低分子肝素使用比例更低(P<0.05),TEG凝血反应时间(TEG-R)缩短(P<0.05)。多因素Logistic回归分析显示,TEG-R、ANA、β2-GP1及启动治疗时孕周均是妊娠期PTS孕妇不良妊娠结局的独立影响因素(P<0.05)。TEG-R的ROC曲线分析显示:曲线下面积为0.632(95%CI 0.551~0.741)。当TEG-R为4.65 min时,特异度为0.948,敏感度为0.302。Kaplan-Meier生存曲线分析示:TEG-R>4.65 min孕妇的妊娠孕周较TEG-R≤4.65 min的孕妇显著延长,差异有统计学意义(P<0.01)。结论:ANA、ACA、β2-GP1以及TEG对于预测、评估妊娠期PTS患者不良妊娠结局具有一定参考意义。在孕期的监测中,TEG-R≤4.65 min可有望用于指导抗凝干预治疗。Objective:To investigate the factors for adverse pregnancy outcomes and the value of thromboelastography(TEG)in patients with prethrombotic state(PTS)during pregnancy.Methods:A total of 183 pregnant women with PTS treated at the Department of Obstetrics,Xiangya Third Hospital,Central South University,from January 2020 to September 2023 were retrospectively analyzed.These women were divided into two groups based on pregnancy outcomes:the favorable pregnancy outcome group(97 cases)and the adverse pregnancy outcome group(86 cases).The risk factors for adverse pregnancy outcomes were evaluated by univariate and multivariate analyses,and the diagnostic value of TEG was assessed using the receiver operating characteristic(ROC)curve and Kaplan-Meier method.Results:The results of univariate analysis indicated that,compared tothe favorable pregnancy outcome group,the positive rates of antinuclear antibody(ANA),anticardiolipin antibody(ACA),and anti-beta2 glycoprotein antibody 1(β2-GP1)were higher in the adverse pregnancy outcome group(P<0.05),and lower utilization rates of hydroxychloroquine and low-molecular heparin(P<0.05),and shorter clotting reaction time in the thromboelastography(TEG-R)(P<0.05).Multivariate Logistic regression analyses revealed that TEG-R,ANA,β2-GP1 and gestational age at treatment initiation were all independent risk factors for adverse pregnancy outcome in pregnant women with PTS during pregnancy(P<0.05).ROC curve analysis showed the area under the curve for TEG-R was 0.632(95%CI 0.551-0.741).At a TEG-R value of 4.65 min,the specificity was 0.948 and the sensitivity was 0.302.Kaplan-Meier survival curve analysis revealed that the gestational weeks of pregnant women with an TEG-R>4.65 min were significantly longer than those with an TEG-R≤4.65 min.These results were statistically significant(P<0.01).Conclusions:ANA,ACA,β2-GP1,and TEG are valuable for predicting and evaluating adverse pregnancy outcomes in PTS patients.The TEG-R value≤4.65 min may serve as a critical threshold to guid anticoa

关 键 词：妊娠期血栓前状态 不良妊娠结局 影响因素 血栓弹力图 

分 类 号：R714.25[医药卫生—妇产科学]