应用血小板功能分析仪PFA-100和血栓弹性描记仪评估健康孕妇和先兆子痫孕妇止血功能的比较研究

背景PFA-100是一种即时血小板功能分析仪，用于测定体外血小板血栓形成的速度，即凝血时间（closure time，CT）。该仪器可用于区域麻醉前的凝血功能评估。本次前瞻性、观察性研究旨在探讨血小板功能分析仪PFA-100和血栓弹性描记仪（thromboelastograph，TEG）对先兆子病和正常分娩者血小板功能的评价能力。本研究首先确立正常妊娠人群中PFA-100和TEG测量值的95％参考区间，然后再用PFA-100和TEG检测分娩时先兆子痫患者和正常孕妇的血小板功能状况，并进行可信区间分析和方差分析。方法常规进行患者的止血和凝血功能检查，同时测量von Willebrand因子、CT和TEG。数据以均数±标准差表示。结果先兆子痫的严重程度与CT延长呈正相关，即使在血小板计数正常的情况下也是如此。在重度先兆子痫患者中，PFA-100测得的CT值（均数±标准差为155±65秒）超过了对照组的95％参考区间（70～139秒）。相比之下，在重度先兆子痫患者中测得的TEG最大振幅（maximum amplitude，MA）（71±8mm）仍位于正常孕妇MA值的95％参考区间（64～82mm）内。结论本研究提示，与先兆子痫严重程度相关联的初期止血功能损害可被PFA-100而不是TEG识别。

BACKGROUND： The PFA-100 is a point-of-care platelet function analyzer which measures the speed of formation of a platelet plug in vitro, expressed as dosure time （CT） in seconds. This device could potentially be used to assess primary hemostasis prior to regional anesthesia. In this prospective, observational study we sought to establish 95% reference intervals for PFA-100 and Thromboelastograph （TEG） values for our normal pregnant population, before comparing the PFA and TEG in measuring platelet function in preedamptic and healthy pregnant women at term, using confidence interval analysis and analysis of variance. METHODS： Routine hematologic and coagulation tests were performed along with yon Willebrand Factor, CT, and TEG measurements. Results are expressed as mean （SD）. RESULTS： Increased severity of preeclampsia was associated with increasing prolongation of CT, even in the presence of normal platelet counts. In severe preedampsia, the PFA-100 CT （mean （SD）： 155 （65） s） exceeded the 95% reference interval of the control group （70-139 s）. In contrast, TEG maximum amplitude （MA） in severe preeclampsia （mean （SD）： 71 （8） mm） remained within the 95% reference interval for MA in normal pregnancy （64-82 mm）. CONCLUSIONS： We condude that impairment of primary hemostatic function with increasing severity of preedampsia was recorded by the PFA-100 but not the TEG.