正常妊娠妇女血栓弹力图参考范围的建立

Thrombelastography in healthy pregnant women and its clinical significance

目的:利用血栓弹力图(thrombelastography,TEG)评价正常妊娠妇女在妊娠不同时期凝血功能的状态,并探讨其临床意义。方法:对正常未孕妇女72例,正常妊娠妇女231例,包括早孕65例,中孕68例,晚孕98例,进行TEG检测;另对正常未孕及各孕期正常妊娠妇女各100例,进行传统凝血功能检测。结果:妊娠期妇女较未孕组反应时间(R值)、凝血时间(K值)显著降低(P<0.01),α角、最大振幅(MA值)、凝血综合指数(CI值)显著升高(P<0.01)。中孕组及晚孕组R值较未孕及早孕组显著缩短(P<0.01),MA值显著增加(P<0.01);K值随孕周增加而显著降低(P<0.01)而α角则显著升高(P<0.01),各孕期均有显著差异。中孕期起,CI值随孕周增大而显著升高(P<0.01)。不同孕期孕妇较未孕组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)及血小板(PLT)计数间亦有不同变化。孕晚期R值及MA值分别与APTT及FIB呈正相关;K值、α角及MA值与PLT间均有显著相关性。结论:妊娠妇女各孕期凝血状态有所不同,TEG可反映妊娠期妇女存在明显的凝血活性增强状态,可作为动态监测孕产妇凝血状态的新方法。

Objective： To assess the coagulation state of healthy pregnant women in different stages of pregnancy by thrombelastography （TEG） and to assess the clinical value of TEG. Methods Seventy- two non-pregnant women and 231 pregnant women, in whom 65 were in early pregnancy, 68 in second trimester and 98 in trimester were enrolled in this study. TEG was used to detect changes in blood coagulation state. Other 100 each of pregnancy at different stages and non-pregnant women were tested for PT, APTT, TT, FIB and PLT. Results R（reaction time） and K （clotting time） values in pregnant women were significantly lower than that in non-pregnant women, while the α angle （clot formation rate）, MA （maximum amplitude） and CI （coagulation index） were significantly higher in pregnant women （P〈0.01）. R and MA values in second trimester and third trimester women were significantly different from that in non-pregnant and early pregnancy women （P〈0.01）. K value decreased with the increase in week of gestation, whereas α angle was in the contrary （P〈0.01）. CI increased significantly with the increase in gestation age （P〈0.01）, except that in early pregnancy and second trimester （P〉0.05）. Compared with non-preguant women, each of the stages of pregnancy showed differences in PT, APTT, TT, FIB and PLT. In third trimester, there was a positive correlation between R value and AIr[T, and between M value and FIB. There was a correlation between PLT and K value, and between α angle and MA value. Conclusions Normal pregnant women presents a significant hypercoagulable state, and there is a marked increase in procoagulant activity, including higher clotting factor activity, fibrinogen level and platelet function. With the increase in gestational age, the level of these markers increases. TEG is an useful indicator for monitoring the dynamics of maternal coagulation status.