正常孕期凝血功能和血栓弹力图参考值界定研究

Study on reference ranges for coagulation function and thromboelastography in normal pregnancy

目的探讨正常孕期凝血功能和血栓弹力图(TEG)参考值的界定对孕妇不同时期血液高凝状态的指导价值,为凝血功能障碍相关疾病的诊治提供理论依据。方法采集2014年11月至2015年10月南通大学附属妇幼保健院产检及体检的女性血液标本进行凝血功能及TEG检查,分组如下:(1)随机抽取正常早、中、晚孕期妇女各400例作为试验1组。(2)同期135例定期产检的孕妇作为试验2组。(3)同期未孕健康育龄期妇女作为对照组。结果与对照组相比,试验1组及2组凝血酶原时间(PT)、抗凝血酶-Ⅲ(AT-Ⅲ)均呈下降趋势,纤维蛋白原(FIB)、凝血酶时间(TT)、D-二聚体(D-D)、纤维蛋白降解产物(FDP)、血管性血友病因子(VWF)呈上升趋势。中、晚孕期试验组FDP、D-D值与现有临床参考值差异具有统计学意义(P<0.05)。与对照组相比,两试验组孕期TEG的凝血时间呈缩短趋势,综合指数呈上升趋势(P<0.05)。最大振幅在试验2组中也呈上升趋势(P<0.05)。结论 (1)随着孕周增加,PT、AT-Ⅲ下降,FIB、D-D、FDP、VWF升高,但早孕期均处于现有临床凝血功能参考值范围内;在中、晚孕期FDP及DD超出现有参考值范围,需要修订。(2)VWF参考值范围可作为临床凝血功能的重要参考指标。(3)TEG可用于临床凝血功能的检测。(4)试验1组所测得的凝血功能指标的变化在很大程度上可代表试验2组的变化。

Objective To explore the reference ranges of coagulation function and TEG in normal pregnancy and its guiding value for the blood hypercoagulability of pregnant women at different periods,and provide a theoretical basis for the diagnosis and treatment of some diseases related to coagulation dysfunction.Methods We collected female blood samples from women undergoing pregnancy check-up and physical examination,who prepared to give birth in Affiliated Women and Children Health Care Hospital of Nantong University from November 2014 to October 2015,for the detection of coagulation function and TEG examination.The groups were as follows（：1）Each 400 normal pregnant women randomly selected in early,middle,and late gestation were used as Group 1;（2）135 pregnant women at the same period with regular examinations as Group 2;（3）unpregnant women at childbearing age of the same period as a control group.Results Compared with the control group,in both Group 1 and 2,PT and AT-Ⅲ decreased,while FIB,TT,D-D,FDP and VWF increased.The difference between the values of FDP and D-D in both groups and the existing clinical reference values had statistical significance（P〈0.05）.Compared with the control group,the R value in both groups showed a downward trend,and the CI value showed an upward trend（P〈0.05）.The MA value in Group 2 also showed an upward trend（P〈0.05）.Conclusion（1）With the increase of gestational age,PT and AT-Ⅲdecrease,while FIB,D-D,FDP and VWF increase,but all are within the reference range of the existing clinical coagulation function in early gestation;but in the middle and late gestation,FDP and D-D are beyond the range of reference values,which need to be revised（.2）The range of VWF reference values can be used as an important reference index for clinical coagulation function.（3）Thromboelastography can be used as the detection of clinical coagulation function.（4）The variations of Group 1,to a large extent,are representative of the variations of Group2.