血栓弹力图在妊娠合并血小板减少症的临床应用研究

Application of thrombelastography in pregnancy with thrombocytopenia

目的：评价血栓弹力图（thrombelastography,TEG）在妊娠合并血小板减少症孕妇凝血功能监测中的应用价值。方法：收集66例妊娠合并血小板减少症孕妇（其中血小板（platelets,PLT）计数（50-99）×109/L孕妇50例,〈50×109/L孕妇16例）（实验组）和同期112例健康孕妇（对照组）,分别进行TEG、凝血酶原时间（prothrombin time,PT）、活化部分凝血活酶时间（activated partial thromboplastin time,APTT）、凝血酶时间（thrombin time,TT）及纤维蛋白原（fibrinogen,Fg）检测,并分析其与PLT值的相关性。结果：与正常对照组相比,实验组反应时间（R值）、凝血时间（K值）、PT值及APTT值均升高,而α角、最大振幅（MA值）与凝血综合指数（CI值）均降低（P〈0.05）;与PLT（50-99）×109/L亚组相比,PLT〈50×109/L亚组K值升高,MA值及CI值均降低（P〈0.05）;K值、MA值及CI值均与PLT值显著相关（相关系数r分别为-0.43、0.51、0.40,P均〈0.05）,其他检测指标与PLT值均无相关性（P〉0.05）。结论：TEG可作为监测妊娠合并血小板减少症孕妇凝血功能状态的有用指标。

Objective To evaluate the application value of thrombelastography（TEG） in monitoring blood coagulation for pregnancy with thrombocytopenia. Methods Totally 66 pregnant women with thrombocytopenia were enrolled in the experiment group, including 50 ones with platelet count between 50 ×109/L and 99×109/L and 16 ones with platelet count less than 50 ×109/L, and 112 healthy pregnant women were involved in the control group. Tests were carried out in the two groups for TEG, prothrombin time（PT）, activated partial thromboplastin time（APTT）, thrombin time（TT）, fibrinogen（Fg）,and the correlation between the test values and platelet count was analyzed. Results R（reaction time）, K（clotting time）,PT and APTT values in pregnant women with thrombocytopenia were significantly higher than those in healthy pregnant women, while the α angle, MA（maximum amplitude） and CI（coagulation index） were significantly lower in pregnant women with thrombocytopenia（P0.05）. Compared with the subgroup with platelet count between 50×109/L and 99×109/L,the subgroup with platelet count less than 50 ×109/L showed a higher K value and lower MA, CI value（P 0.05）. There was significant correlation between PLT value and K, MA, CI values, respectively（r=-0.43, 0.51, 0.40, respectively; P0.05）, while no correlation between PLT value and any other measurements（P 0.05）. Conclusion TEG can be used as a useful indicator in monitoring blood coagulation for pregnancy with thrombocytopenia.