低纤维蛋白原水平是HELLP综合征产妇不良预后危险因素

Hypofibrinogenemia is a risk factor of poor prognosis of HELLP syndrome

目的观察产妇止血系统变化用于判断HELLP综合征的严重程度和预后。方法入选在2010年8月至2018年8月在北京大学第三临床医学院诊断的HELLP综合征127例。收集产妇和胎儿人口学特征、产后并发症、住院天数和临产前凝血酶原时间(PT)、活化的部分凝血酶原时间(APTT)、纤维蛋白原(Fg)和D-二聚体(D-D)数据。结果HELLP综合征产妇产后出血组与非出血组临产前PT[9.6(9.0,11.5)svs9.4(8.9,9.7)s,P=0.243]、APTT[30.2(29.1,38.3)svs29.8(27.7,31.8)s,P=0.151]、D-D[0.80(0.52,4.52)μg/mlvs0.91(0.55,2.48)μg/ml,P=0.923]水平差异无统计学意义;而两组间临产前Fg水平[(2.94±1.48)g/Lvs(3.61±1.00)g/L,P=0.022]差异有统计学意义。ROC分析显示,Fg水平判断产后出血的AUC为0.688(95%CI:0.600~0.767);取临界值3.04g/L,阴性预测值为74.3%;且临产前Fg水平与HELLP综合征产妇住院天数成负性相关(r=-0.182,P=0.040)。HELLP综合征分娩后胎儿存活组(n=93)与未存活组(n=34)之间,以及存活胎儿中发生窘迫组(n=23)与未窘迫组(n=70)之间,母亲临产前PT、APTT、Fg和D-D水平差异均无统计学意义(P>0.05)。结论临产前低Fg水平可能是HELLP综合征产妇不良临床结局的危险因素,通过干预维持Fg在一定水平可能可以减少HELLP产妇不良结局的发生。

Objective Observing changes in thehaemostatic system to determinetheseverity and prognosis of HELLP syndrome. Methods 127 cases of HELLP syndrome diagnosed in Peking University Third Hospital were enrolled from August 2010 to August 2018. Maternal and fetaldemographic characters, postpartum complications,length of hospital stay,prothrombin time(PT),activated partial thromboplastin time (APTT), Fibrinogen(Fg) and D-Dimer(D-D) were collected. Results There was no statistical difference inparturient PT, APTT, D-D levels between maternals of HELLP syndrome with and without postpartum hemorrhage,which were [9.6 (9.0, 11.5)s vs 9.4 (8.9, 9.7)s, P=0.243],[30.2 (29.1, 38.3)s vs 29.8 (27.7, 31.8)s, P=0.151], and [0.80 (0.52, 4.52)μg/ml vs 0.91 (0.55, 2.48)μg/ml, P=0.923] respectively. There was a statistically significant difference obvious difference in parturient Fglevels between two groups [(2.94±1.48) g/L vs (3.61±1.00)g/L, P=0.022). The receiver operating characteristic curve(ROC) analysis showed that the AUC of fibrinogen level when estimating postpartum hemorrhage was 0.688(95%CI: 0.600-0.767), cut-off value was 3.04 g/L, negative predictive value was 74.3%. There was a negative correlation between parturient Fg and days of hospital stay of HELLP syndrome maternal(r=-0.182, P=0.040). There was no statistical difference in parturient PT, APTT, Fg and D-D levels between the fetal survival group(n=93) and non-survival group (n=34), and between the distressed group (n=23) and he undistressed group(n=70)(P>0.05). Conclusions The low parturient Fg level may be a risk factor of maternal adverse clinical outcomes in HELLP syndrome. Maintaining the Fg at a stable level may reduce the incidence of HELLP syndrome adverse outcomes.