摘要
目的:孕产妇数量逐年上升,与凝血功能异常相关的不良妊娠事件增多。对孕妇进行凝血功能评估并及时干预至关重要。本研究旨在分析妊娠期女性血栓弹力图(thrombelastography,TEG)参数的影响因素,探讨TEG指标对孕妇凝血状态的评估作用。方法:回顾性分析2018年至2020年在中南大学湘雅医院产科住院的449例孕妇的临床资料,对比不同年龄、受孕方式、妊娠阶段的健康孕妇间TEG参数的差异,分析妊娠期高血压疾病(hypertensive disorders in pregnancy,HDP)、妊娠期糖尿病(gestational diabetes mellitus,GDM)及同时合并两种疾病对孕妇TEG各参数的影响。结果:与中孕组相比,晚孕组孕妇TEG中的R值、K值增加,α角减小,CI值、LY30值减少(均P<0.05)。HDP组与健康组孕妇相比,TEG中R值、CI值的差异均有统计学意义(均P<0.05)。GDM组、同时合并HDP及GDM组与健康组孕妇相比,TEG各项参数的差异均无统计学意义(均P>0.05)。多元线性回归分析显示:TEG中R值的影响因素为妊娠周数(P<0.001)及受孕方式(P<0.05),α角的影响因素为妊娠周数(P<0.05),MA值的影响因素为受孕方式(P<0.05),CI值的影响因素为妊娠周数(P<0.05)。TEG与血小板(platelet,PLT)及常规凝血指标的相关性分析显示:TEG的R值与活化部分凝血活酶时间(activated partial thromboplastin time,APTT)呈正相关(P<0.01),与CI值呈负相关(P<0.05);K值与纤维蛋白原(fibrinogen,FIB)呈负相关(P<0.05);α角(P<0.05)、MA值(P<0.01)及CI值(P<0.05)与FIB呈正相关。结论:妊娠不同时期TEG各指标存在相应变化,不同受孕方式对TEG参数结果有影响。TEG各参数与常规凝血功能检测的结果相关,且有较好的一致性。TEG可作为凝血功能的评估手段,及时发现孕产妇的异常凝血状态,有利于尽早预防严重并发症的发生。
Objective: The number of gestational women has been increased in recent years, resultingin more adverse pregnancy outcomes. It is crucial to assess the coagulation function of pregnant women and to intervene in a timely manner. This study aims to analyze theinfluencing factors on thrombelastography (TEG) and explore the evaluation of TEG forgestational women.Methods: A retrospective study was conducted on 449 pregnant women who werehospitalized in the obstetrics department in Xiangya Hospital of Central South Universityfrom 2018 to 2020. We compared the changes on the TEG parameters among normalpregnant women between different age groups, different ingravidation groups, and differentstages of pregnancy groups. The influence on TEG of hypertensive disorders in pregnancy(HDP) and gestational diabetes mellitus (GDM) as well as two diseases synchronizationwas explored.Results: Compared with the normal second trimester women, the R values and K values ofTEG were increased, and α angle, CI values and LY30 values were decreased in thirdtrimester women (all P<0.05). Compared with normal group, the R values and CI values ofTEG of the HDP group have significant difference (both P<0.05). There were nosignificant difference of TEG between the GDM group, the HDP combined with GDMgroup and the normal group (all P>0.05). Multiple linear regression analysis showed thatthe influencing factors for R value in TEG were weeks of gestation (P<0.001) and mode ofconception (P<0.05), for α angle was weeks of gestation (P<0.05), for MA value was modeof conception (P<0.05), and for CI value was weeks of gestation (P<0.05). The analysis ofcorrelation between TEG with platelet (PLT) and coagulation routines represented thatthere was a correlation between TEG R values and activated partial thromboplastin time(APTT) (P<0.01), and negative correlation between TEG CI values and APTT (P<0.05).There was a negative correlation between TEG K values and FIB (P<0.05). The correlationof α angle (P<0.05), MA values (P<0.01) and CI values (P<0.05) with FIB were positiverespectively.Conclusion: The TEG parameters of 3 stages of pregnancy were different. The differentingravidation approach has effect on TEG. The TEG parameters were consistent withconventional coagulation indicators. The TEG can be used to screen the coagulation statusof gestational women, recognize the abnormalities of coagulation and prevent the severecomplication timely.
作者
曹月晴
梁婷
彭捷
赵谢兰
CAO Yueqing;LIANG Ting;PENG Jie;ZHAO Xielan(Department of Hematology,Xiangya Hospital,Central South University,Changsha 410008,China)
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2023年第2期198-205,共8页
Journal of Central South University ：Medical Science
基金
湖南省自然科学基金(2020JJ4930)。
关键词
妊娠
血栓弹力图
凝血功能
影响因素
pregnancy
thrombelastography
coagulation function
influencing factors
