基于血栓弹力图监测孕晚期血小板减少症患者凝血功能的研究

Study on monitoring of coagulation function in patients with thrombocytopenia in the third trimester based on thromboelastography

目的比较血栓弹力图(TEG)与传统凝血四项分析孕晚期血小板减少症患者凝血功能的差异。方法将宁波大学附属李惠利医院2018年6月至2019年6月间收治的73例孕晚期血小板减少症患者作为血小板减少症组,将同时期50例正常孕晚期孕妇作为对照组,根据血小板计数(PLT)水平将血小板减少症组患者分为Ⅰ组(PLT:80~99×10~9/L,26例)、Ⅱ组(PLT:50~79×10~9/L,34例)、Ⅲ组(PLT<50×10~9/L,13例),血小板减少症组与对照组均进行TEG和传统凝血四项检查,TEG包括凝血反应时间(R)、凝固时间(K值)、凝固角(α角)、最大振幅(MA)及凝血综合指数(CI),传统凝血四项包括凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)及纤维蛋白原(FIB),比较四组患者传统凝血四项及TEG检查参数,分析孕晚期血小板减少症患者PLT水平与凝血四项及TEG参数的关系。结果血小板减少症Ⅰ、Ⅱ、Ⅲ组及对照组间PT、APTT、TT、FIB水平比较差异均无统计学意义(均P>0.05)。血小板减少症Ⅰ、Ⅱ、Ⅲ组及对照组间K、MA、CI值比较差异均有统计学意义(F值分别为46.486、31.142、37.806,均P<0.05),R及α角比较差异均无统计学意义(均P>0.05);进一步两两比较显示,Ⅲ组K水平高于对照组与Ⅰ组,Ⅱ、Ⅲ组的MA、CI值均低于对照组及Ⅰ组(q=2.203~8.043,均P<0.05),Ⅲ组K水平高于Ⅱ组,MA、CI值低于Ⅱ组(q值分别为7.550、4.713、5.450,均P<0.05)。相关性分析显示,血小板减少症组PLT水平与PT、ATPP、TT、FIB水平无明显相关性(均P>0.05),与TEG参数R、K呈负相关(r值分别为-0.134、-0.563,均P<0.05),与α角、MA、CI值呈正相关(r值分别为0.612、0.641、0.594,均P<0.05)。结论与传统凝血四项相比,TEG在监测孕晚期血小板减少症患者凝血功能中的临床应用价值更高。

Objective To compare the difference of thromboelastography(TEG)and routine coagulation test(four items)in analyzing the coagulation function for pregnant patients with thrombocytopenia in late pregnancy.Methods 73women with thrombocytopenia(thrombocytopenia group)and 50normal pregnant women(control group)during the third trimester were enrolled,that were admitted to Li Huili Hospital Affiliated to Ningbo University from June 2018to June 2019.The patients in thrombocytopenia group were further divided into three groups:groupⅠ(PLT:80~99×109/L,n=26),groupⅡ(PLT:50~79×109/L,n=34),and groupⅢ(PLT<50×109/L,n=13),according to the platelet count(PLT).All the subjects in thrombocytopenia group and control group underwent TEG and routine coagulation test,TEG test parameters included coagulation reaction time(R),coagulation time(K),coagulation angle(αangle),maximum amplitude(MA)and coagulation composite index(CI).The routine coagulation test parameters included prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(FIB).Then the parameters of TEG and routine coagulation test were compared,and the correlation between PLT level and the parameters of TEG and routine coagulation test for patients with thrombocytopenia during the third trimester were analyzed.Results There were no significance for the level of PT,APTT,TT,and FIB in groupsⅠ,Ⅱ,Ⅲand control group(all P>0.05).There were significant difference for the level of K,MA and CI value in groupsⅠ,Ⅱ,Ⅲand control group(F=46.486,31.142,37.806,respectively,all P<0.05).And There were no significance for R andαAngle among the four groups(all P>0.05).The further analysis showed that the level of K in groupⅢwas higher than that in control group and groupⅠ.The level of MA and CI value in groupⅡandⅢwere lower than that in control group and groupⅠ(q=2.203~8.043,all P<0.05).The level of K in groupⅢwas higher than that in groupⅡ,and the level of MA and CI value in groupⅢwas lower than that in groupⅡ(q=7.550,4.713,5.450,respectively,all P<0.05).Correlation analysis showed that for patients in thrombocytopenia group,there were no significant association between the level of PLT and PT,ATPP,TT,and FIB(all P>0.05),negative association between the level of PLT and TEG parameters R and K(r=-0.134and-0.563,respectively,both P<0.05),and positive association between the level of PLT andαangle,MA and CI values(r=0.612,0.641,0.594,respectively,all P<0.05).Conclusion Compared with routine coagulation test,TEG has a higher clinical application value in monitoring coagulation function in patients with thrombocytopenia in the third trimester.