子痫前期患者检测凝血、抗凝和纤溶实验室指标的价值分析

Value analysis of laboratory indicators for blood coagulation, anticoagulation and fibrinolysis in patients with preeclampsia

目的观察凝血、抗凝及纤溶指标在不同程度妊娠期高血压病患者中的水平变化及对母婴结局的影响。方法回顾性分析2017年8月～2018年8月在深圳市妇幼保健院分娩的130例妊娠期高血压病孕产妇的临床资料,其中妊娠期高血压41例,轻度子痫前期51例,重度子痫前期38例;另选取同期在深圳市妇幼保健院分娩的健康孕产妇40例,分析其凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、抗凝血酶-Ⅲ(AT-Ⅲ)、D-二聚体(D-D)、组织纤溶酶原激活物(t-PA)、纤溶酶原激活抑制物-1(PAI-1)、纤维蛋白原(FIB)、纤维蛋白原降解产物(FDP)水平在不同时期妊娠期高血压病中的水平变化,记录妊娠期高血压病孕产妇不良母婴结局(胎盘早剥、产后出血、胎儿生长受限、宫内窘迫、早产、死胎/死产)发生情况。结果妊娠期高血压病孕产妇的PT、APTT均短于健康孕产妇,AT-Ⅲ指标水平低于健康孕产妇,D-D、t-PA、PAI-1、FIB、FDP水平短高于健康孕产妇,差异有统计学意义(P<0.05)。在妊娠期高血压病不同时期孕产妇中,重度子痫前期孕产妇的PT、APTT均短于轻度子痫前期和妊娠期高血压孕产妇,AT-Ⅲ水平低于轻度子痫前期和妊娠期高血压孕产妇,D-D、PAI-1、FDP、FIB水平均高于轻度子痫前期和妊娠期高血压孕产妇,差异有统计学意义(P<0.05)。存在不良母婴结局孕产妇的AT-Ⅲ水平低于无不良结局孕产妇,PAI-1水平高于无不良结局孕产妇,差异有统计学意义(P<0.05)。结论妊娠期高血压病特别是子痫前期孕产妇血液呈异常高凝状态,早期动态检测凝血、抗凝、纤溶指标有助于预防不良母婴结局的发生。

Objective To observe the changes of blood coagulation, anticoagulation and fibrinolysis indicators in patients with pregnancy-induced hypertension at different degrees and their effects on maternal and fetal outcomes. Methods A retrospective analysis of clinical data of 130 pregnant women with pregnancy-induced hypertension during the delivery from August 2017 to August 2018 in Shenzhen Maternal and Child Health Care Hospital was made, including 41 cases gestational hypertension, 51 cases mild preeclampsia, and 38 cases severe preeclampsia. Meanwhile, another 40 cases of healthy pregnant women who delivered in Shenzhen Maternal and Child Health Care Hospital were enrolled. The prothrombin time (PT), activated partial thrombin time (APTT), antithrombin-Ⅲ(AT-Ⅲ), D-dimer (D-D), tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), fibrinogen (FIB), and fibrinogen degradation products (FDP) levels of gestational hypertension in different periods were analyzed. The occurrence of adverse maternal outcomes in pregnancy-induced hypertension women such as placental abruption, postpartum hemorrhage, fetal growth restriction, intrauterine distress, premature delivery, and stillbirth was recorded. Results The PT and APTT in pregnant women with gestational hypertension were shorter than those in healthy pregnant women, the level of AT-Ⅲ was lower than that in the healthy pregnant women, and the levels of D-D, t-PA, PAI-1, FIB and FDP were higher than those in the healthy pregnant women, with statistically significant differences (P<0.05). In pregnant women at different stages of hypertensive gestation, the PT and APTT in severe preeclampsia were shorter than those in mild preeclampsia and gestational hypertension, the level of AT-Ⅲ in severe preeclampsia was lower than that in mild preeclampsia and gestational hypertension, and the levels of D-D, PAI-1, FDP and FIB were higher than those in mild preeclampsia and gestational hypertension, with statistically significant differences (P<0.05). The level of maternal AT-Ⅲ in patients with adverse maternal and infant outcomes was lower than that without adverse maternal outcome, the level of PAI-1 was higher compared with that without adverse outcomes, with statistically significant differences (P<0.05). Conclusion Women with pregnancy-induced hypertension, especially in preeclampsia, is abnormally hypercoagulable. Early detection of blood coagulation, anticoagulation and fibrinolysis can prevent the occurrence of adverse maternal and child outcomes.