摘要
目的:观察妊娠期高血压疾病(PIH)患者孕中期血小板参数、钙离子(Ca^(2+))浓度、凝血指标与病情程度及母婴结局的关系。方法:选取120例PIH患者作为PIH组,根据病情程度将其分为轻度组、中度组及重度组,另外选取同期100例健康孕妇作为对照组,比较各组患者孕中期血小板参数[血小板计数(PLT)、血小板分布宽度(PDW)、平均血小板体积(MPV)]、Ca^(2+)浓度及凝血指标[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)]水平。根据PIH组母婴结局将其进一步分为不良结局组与良好结局组,采用受试者工作特征(ROC)曲线分析其对PIH患者母婴结局的预测价值。结果:PIH组患者PLT、Ca^(2+)浓度、PT、APTT低于对照组(均P<0.05),PDW及FIB高于对照组(均P<0.05)。轻度组患者PLT、Ca^(2+)浓度、PT、APTT高于中度组与重度组,PDW低于中度组与重度组(均P<0.05),且Spesrman相关性分析显示,PIH患者病情严重程度与PLT、Ca^(2+)浓度、PT、APTT呈负相关,与PDW水平呈正相关(均P<0.05)。120例PIH患者中,共34例出现不良母婴结局(早产15例、新生儿窒息10例、宫内窘迫8例、围产期死亡1例),不良结局组患者PLT、Ca^(2+)浓度、PT、APTT均低于良好结局组(均P<0.05)。ROC特征曲线结果显示,PLT、Ca^(2+)浓度、PT、APTT预测母婴结局的最佳截断值分别为143.760×10^(9)、2.875 mmol/L、10.715 s及29.020 s,且四项指标联合预测PIH患者母婴结局的AUC及敏感度均高于单一指标预测(均P<0.05)。结论:PIH患者病情严重程度与PLT、Ca^(2+)浓度、PT、APTT及PDW水平密切相关,且PLT、Ca^(2+)浓度、PT联合APTT对PIH患者母婴结局具有较高的预测价值,建议临床予以重点关注。
Objective:To observe the relationship between platelet parameters,calcium ion(Ca^(2+))concentration and coagulation indicators in the second trimester of pregnancy and condition,maternal-fetal outcomes of patients with pregnancy induced hypertension(PIH).Methods:A total of 120 patients with PIH were selected as the PIH group,and the patients were divided into mild group,moderate group and severe group according to disease severity.At the same time,100 healthy pregnant women were selected as the control group.The platelet parameters(platelet count[PLT],platelet distribution width[PDW]and mean platelet volume[MPV]),Ca^(2+)concentration and coagulation indicators(prothrombin time[PT],thrombin time[TT],activated partial thromboplastin time[APTT]and fibrinogen[FIB])in different groups were compared.According to maternal-infant outcomes,patients with PIH were divided into the adverse outcome group and the good outcome group.The predictive value of above indicators for maternal-infant outcomes of patients with PIH was analyzed by using ROC curve.Results:PLT,Ca^(2+)concentration,PT and APTT in the PIH group were lower or shorter than those in the control group,PDW and FIB were higher than those in the control group(all P<0.05).PLT,Ca^(2+)concentration,PT and APTT in the mild group were higher or longer than those in the moderate group and the severe group,PDW was lower than that in the moderate group and the severe group(all P<0.05).Spearman correlation analysis found that the severity of PIH was negatively correlated with PLT,Ca^(2+)concentration,PT and APTT,and positively correlated with PDW(all P<0.05).Among 120 PIH patients,a total of 34 cases had adverse maternal-infant outcomes(15 cases of premature delivery,10 cases of neonatal asphyxia,8 cases of intrauterine distress,and 1 case of perinatal death).PLT,Ca^(2+)concentration,PT,and APTT in the adverse outcome group were lower than those in the good outcome group(all P<0.05).The ROC curve analysis results showed that the best cutoff values of PLT,Ca^(2+)concentration,PT and APTT for predicting maternal-infant outcomes were 143.760×10^(9),2.875 mmol/L,10.715 s and 29.020 s.The AUC and sensitivity of combined prediction with the four indicators were higher than those of prediction with single indicator(all P<0.05).Conclusion:The severity of PIH is closely related to PLT,Ca^(2+)concentration,PT,APTT and PDW.The combination of PLT,Ca^(2+)concentration,PT and APTT is of high value in predicting maternal-infant outcomes of patients with PIH,which deserves special attention in clinical practice.
作者
周立娜
张蕾
孙晓娜
于春燕
白娅琴
ZHOU Lina;ZHANG Lei;SUN Xiaona;YU Chunyan;BAI Yaqin(Department of Obstetrics,Shijiazhuang Maternal and Child Healthcare Hospital,Shijiazhuang 050051,China)
出处
《陕西医学杂志》
CAS
2024年第2期257-261,共5页
Shaanxi Medical Journal
基金
河北省医学科学研究计划项目(20211762)。
关键词
妊娠期高血压疾病
血小板参数
钙离子浓度
凝血指标
病情程度
母婴结局
Pregnancy induced hypertension
Platelet parameter
Calcium ion concentration
Coagulation indicator
Degree of illness
Maternal-infant outcomes
