凝血三项、D-二聚体检测联合血栓弹力图判断孕妇凝血状态的临床价值

Clinical significance of three items of coagulation,D-Dimer detection combind with thromboelastography in judging the coagulation status of pregnant women

目的:探讨临产孕妇血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)检测联合血栓弹力图(TEG)检测用于判断孕妇凝血状态的临床价值。方法:以在琼海市妇幼保健院接受临产检查的孕妇160例为观察组,另选择未妊娠健康女性80例为对照组,分析两组凝血三项(PT、APTT、FIB)、D-D及TEG检测的结果,以及凝血三项、D-D值与TEG检测值的关系。根据凝血三项、DD及TEG参数是否异常,将观察组再分为异常组(凝血三项、D-D及TEG参数至少2项异常)和正常组,分析凝血三项、D-D及TEG参数与静脉血栓栓塞、弥散性血管内凝血(DIC)、胎膜早破、产后大出血、新生儿体质异常、产妇死亡、新生儿死亡等的关系。结果:观察组PT、APTT短于对照组(均P <0. 05),TEG的凝血反应时间(R值)、血块形成时间(K值)低于对照组(均P <0. 05);观察组FIB、D-D水平及TEG最大振幅(MA值)高于对照组(均P <0. 05)。TEG的R、K值与PT、APTT水平呈正相关,与FIB、D-D水平呈负相关(均P <0. 05);MA值与PT、APTT呈负相关,与FIB、D-D水平呈正相关(P <0. 05)。传统常规凝血试验与TEG检测对评估高凝状态具有较好的一致性(Kappa值=0. 812)。异常组静脉栓塞、DIC、胎膜早破、产后大出血、新生儿体质异常、产妇死亡、新生儿死亡等的总发生率高于正常组(P <0. 05)。结论:凝血三项、D-D检测联合TEG有助于科学评估临产孕妇的凝血功能,预测临床孕妇的妊娠结局,为围产期大出血、DIC的预防及治疗提供参考依据。

Objective: To explore the clinical significance of plasma prothrombin time( PT),activated partial thromboplastin time( APTT),fibrinogen( FIB),D-dimer( D-D) and thromboela-stogram( TEG) in judging the coagulation status for pregnant women. Methods: One hundred and sixty cases of pregnant women undergoing labor examination in Qionghai Maternal and Child Health Hospital were selected as observation group,another 80 healthy women without pregnancy were selected as control group. The results of three items of coagulation( PT,APTT,FIB),D-D test and TEG test of the two groups and the relationship between the three items of coagulation,D-D and TEG were analyzed. According to whether three items of coagulation,D-D and TEG parameters were normal or not,the pregnant women in the observation group were divided into abnormal group( at least two abnormalities were found in three items of coagulation,D-D and TEG parameters) and normal group,the relationship between three items of coagulation, D-D,TEG parameters and the incidence of venous thromboembolism, disseminated intravascular coagulation( DIC),premature rupture of membranes,postpartum hemorrhage,abnormal neonatal constitution,maternal death and neonatal death were analyzed. Results: PT and APTT in the observation group were shorter than those in the control group( all P < 0. 05),The coagulation reaction time( R value) and clot formation time( K value) of TEG in the observation group were lower than those in the control group( all P <0. 05). The levels of FIB and D-D and the maximum amplitude( MA value) of TEG in the observation group were higher than those in the control group( all P < 0. 05). The R and K values of TEG were positively correlated with PT and APTT,but negatively correlated with FIB and D-D levels( all P < 0. 05). MA value of TEG was negatively correlated with PT and APTT,and positively correlated with FIB and D-D levels( P < 0. 05). Traditional routine coagulation test had good consistency with TEG test in evaluating hypercoagulability( Kappa value = 0. 812). The total incidence of vein embolism,DIC,premature rupture of membranes,postpartum hemorrhage,abnormal neonatal constitution,maternal death and neonatal death of the abnormal group were higher than those of the normal group( P < 0. 05). Conclusion: Combination of the three coagulation tests,D-D test and TEG test can help to scientifically evaluate the coagulation function of pregnant women,predict the pregnancy outcome of clinical pregnant women,and provide reference for the prevention and treatment of perinatal massive hemorrhage and DIC.