凝血功能指标和血小板参数对子痫前期及其严重程度的辅助诊断价值研究

Assistant Diagnosis for Coagulation Function and Platelet Parameters in the Diagnosis of Preeclampsia and Its Severity

背景子痫前期是一种严重的妊娠期并发症,用凝血功能指标和血小板参数的最佳截断值可以筛查子痫前期,但目前对测试结果的解释常常存在争议。目的探讨凝血功能指标和血小板参数对子痫前期及其严重程度的辅助诊断价值。方法选取2016年5月-2018年9月于山西医科大学第二医院分娩的325例孕妇为研究对象,包括健康组100例、妊娠期高血压组46例、轻度子痫前期组48例及重度子痫前期组131例。比较四组孕妇一般临床资料、凝血功能指标〔凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、纤维蛋白原(FIB)〕和血小板参数〔血小板计数(PLT)、血小板平均体积(MPV)、血小板分布宽度(PDW)、血小板比容(PCT)、血小板计数/血小板平均体积(PLT/MPV)〕。采用受试者工作特征(ROC)曲线分析凝血功能指标和血小板参数对子痫前期及其严重程度的辅助诊断价值。结果四组孕妇间分娩孕周、孕前体质指数(BMI)、收缩压、舒张压、新生儿体质量、凝血功能指标(PT、APTT、INR、FIB)、血小板参数(PLT、MPV、PDW、PCT、PLT/MPV)比较,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,APTT、MPV、PDW对子痫前期有辅助诊断价值〔ROC曲线下面积(AUC)分别为0.61、0.63、0.66,P<0.05〕;APTT对子痫前期严重程度有辅助诊断价值(AUC=0.67,P<0.05);联合检测PT、APTT、INR、FIB、PLT、MPV、PDW、PCT、PLT/MPV对子痫前期及其严重程度的辅助诊断价值较高(AUC分别为0.78、0.75,P<0.05)。结论 APTT、MPV、PDW对子痫前期有辅助诊断价值,APTT对子痫前期严重程度有辅助诊断价值,联合APTT和其他凝血功能指标、血小板参数对子痫前期及其严重程度的辅助诊断价值更高。

Background Preeclampsia(PE)is a serious complication of pregnancy.The best cut-off values of coagulation function and platelet parameters can be used to screen for preeclampsia,but the interpretation of test results is often controversial.Objective To explore the value of coagulation function and platelet parameters in the assistant diagnosis of preeclampsia and its severity.Methods A total of 325 pregnant women delivered in the Second Hospital of Shanxi Medical University from May 2016 to September 2018 were selected as the study subjects,including 100 cases in the health group,46 cases in the gestational hypertension(GH)group,48 cases in the mild preeclampsia(mPE)group and 131 cases in the severe preeclampsia(sPE)group.The general clinical data,coagulation function indexes〔prothrombin time(PT),activated partial thromboplastin time(APTT),international normalized ratio(INR),fibrinogen(FIB)〕and platelet parameters〔platelet count(PLT),mean platelet volume(MPV),platelet distribution width(PDW),plateletcrit(PCT),platelet count/mean platelet volume(PLT/MPV)〕of four groups of pregnant women were compared.The ROC curve was used to analyze the assistant diagnostic value of coagulation function and platelet parameters for preeclampsia and its severity.Results There were significant differences in the gestational weeks, the body mass index(BMI), systolic blood pressure,diastolic blood pressure,neonatal body mass, blood coagulation function(PT,APTT,INR,FIR) and platelet parameters(PLT,MPV,PDW,PCT,PLT/MPV)between the four groups of pregnant women(P<0.05).The results of ROC curve analysis showed that APTT,MPV,PDW have auxiliary diagnostic value for pre-eclampsia〔the area under ROC curve(AUC)were 0.61,0.63,0.66,respectively,P<0.05〕;APTT has auxiliary diagnostic value for pre-eclampsia severity(AUC=0.67,P<0.05),combined detection of APTT,PT,INR,FIB,PLT,MPV,PDW,PCT and PLT/MPV have a higher auxiliary diagnostic value for preeclampsia and its severity(AUC were 0.78, 0.75 respectively,P<0.05). Conclusion APTT,MPV and PDW are helpful in the diagnosis of pre-eclampsia,and APTT is helpful in the diagnosis of the severity of pre-eclampsia.APTT combined with other coagulation function indicators and platelet parameters is more helpful in the diagnosis of pre-eclampsia and its severity.