孕晚期合并血小板减少患者凝血指标的临床研究

Clinical study of coagulation index in late pregnancy patients with thrombocytopenia

目的分析孕晚期妊娠合并血小板减少患者凝血各指标的特点,观察不同血小板水平产妇的出血量,为临床评估提供参考。方法收集在陕西省人民医院产科建档且定期产检,并于2017年9月至2018年4月间分娩的单胎孕晚期(孕≥28周)妊娠合并血小板减少患者123例,按分娩前血小板计数水平将患者分为轻度组(100×10^9/L~<150×10^9/L)38例、中度组(50×10^9/L~<100×10^9/L)60例、重度组(<50×10^9/L)25例,以同期正常孕产妇56例为对照组。抽取分娩前肘正中静脉血行血常规、凝血四项、血栓弹力图(TEG)检测,观察各组的凝血指标特点。记录产妇产时和产后24小时的出血量,比较不同血小板水平与出血量的相关性。结果在血常规四项指标中,四组的PLT和PCT比较差异均有统计学意义(F值分别为321.724、209.590,均P<0.05);在凝血四项指标中,四组的纤维蛋白原(Fig)比较差异有统计学意义(F=3.510,P<0.05);在TEG五项指标中,K、Angle、MA和CI值比较差异均有统计学意义(F值分别为6.102、8.030、43.091、13.576,均P<0.05)。不同血小板水平各组出血量比较差异无统计学意义(F=0.972,P>0.05)。结论 TEG指标较传统凝血四项能更好地反馈不同血小板水平下产妇凝血状态。妊娠合并血小板减少患者临床评估不仅需考虑血小板计数,还需评价血小板功能,并结合产科原发病及血小板减少原因进行综合评估。

Objective To analyze the characteristics of coagulation indexes in late pregnancy with thrombocytopenia and to observe the blood loss of parturients with different platelet levels, so as to provide reference for clinical evaluation. Methods A total of 123 late singleton pregnant women(gestation weeks≥28) with thrombocytopenia who were filed in obstetrics department and accepted regular obstetric examinations in Shaanxi People’s Hospital and delivered between September 2017 and April 2018 were collected. According to the level of platelet count before delivery, the patients were divided into mild group(100×10^9/L-<150×10^9/L) with 38 cases, moderate group(50×10^9/L-100×10^9/L) with 60 cases, severe group(<50×10^9/L) with 25 cases, and 56 normal pregnant women delivered in the same period were selected in control group. Blood samples from median elbow vein before delivery were taken for routine blood test, four items of coagulation and thromboelastogram(TEG) test to observe the characteristics of coagulation indicators in each group. The blood loss during delivery and 24 hours after delivery was recorded, and the correlation between different platelet levels and blood loss was compared. Results There were significant differences in platelets(PLT) and thrombocytocrit(PCT) among the four blood routine indexes(F value was 321.724 and 209.590, respectively, both P<0.05). There was significant difference in fibrinogen(Fg) among four coagulation indexes(F=3.510, P<0.05). Among five TEG indicators, K, Angle, MA and CI value were significantly different(F value was 6.102, 8.030, 43.091 and 13.576, respectively, all P<0.05). There was no significant difference in the amount of bleeding among groups with different platelet levels(F=0.972, P>0.05). Conclusion TEG can better feedback maternal coagulation condition at different platelet levels than the traditional four coagulation indexes. The clinical evaluation of pregnancy with thrombocytopenia needs not only to consider the platelet count, but also to combine obstetric diseases and platelet function.