血栓弹力图在妊娠期糖尿病孕妇凝血功能检测中的应用价值

Application value of thrombelastography in detection of blood coagulation function in women with gestational diabetes mellitus

目的探讨血栓弹力图(TEG)在妊娠期糖尿病(GDM)孕妇凝血功能检测中的应用价值。方法回顾性分析2017年10月~2019年10月于安徽医科大学附属巢湖医院分娩的142例孕妇的临床资料,根据孕妇是否患有GDM将其分为GDM组(70例)和对照组(72例)。比较两组孕妇的常规凝血功能、血小板(PLT)水平和TEG指标,并对GDM组中有统计学差异的常规凝血功能指标和TEG指标进行相关性分析。结果GDM组孕妇的外周血凝血酶原时间(PT)长于对照组,纤维蛋白原(FIB)高于对照组,差异有统计学意义(P<0.01),且两组的FIB值均高于正常值范围。两组孕妇的活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、D-二聚体(D-D)、PLT水平比较,差异无统计学意义(P>0.05)。GDM组孕妇的外周血凝血综合指数(CI)、最大振幅(MA)、血凝块力学强度(G)及振幅(A)均高于对照组,差异有统计学意义(P<0.05)。两组孕妇的反应时间(R)、凝血时间(K)、血块生成率(α角)比较,差异无统计学意义(P>0.05)。GDM组孕妇CI、G、A与PT成正相关关系(P<0.05),CI、MA、G、A与FIB成正相关关系(P<0.05)。结论GDM孕妇血液容易形成血栓,且血栓不易脱落,GDM孕妇出血的风险也高于正常孕妇,TEG相关指标与传统凝血指标比较具有显著相关性,对GDM孕妇进行TEG检测优于传统凝血功能检测,能准确监测孕妇的血液状态,为临床抗凝和止血治疗提供依据。

Objective To explore the application value of thrombelastography (TEG) in detection of blood coagulation function in women with gestational diabetes mellitus (GDM). Methods Clinical data of 142 GDM pregnant women who delivered in Chaohu Hospital of Anhui Medical University from October 2017 to October 2019 was were retrospectively analyzed and divided into the GDM group (70 cases) and the control group (72 cases) according to whether the pregnant women had GDM. The routine coagulation function, level of platelet (PLT) and TEG indicators were compared between the two groups. And the correlation analysis was conducted in routine coagulation function indicators and TEG indicators with statistical differences in the GDM group. Results The prothrombin time (PT) in the peripheral blood of the GDM group was longer than that of the control group, the fibrinogen (FIB) was higher than that of the control group, and the differences were statistically significance (P<0.01). The FIB values of the two groups were both higher than the normal range. There were no statistically significant differences in the activated partial thromboplastin time (APTT), thrombin time (TT), D-dimer (DD) and level of PLT between the two groups (P>0.05). The peripheral blood coagulation comprehensive index (CI), maximum amplitude (MA), blood clot mechanical strength (G) and amplitude (A) in the GDM group were higher than those in the control group, and the differences were statistically significant (P<0.05). There were no statistically significant differences in the reaction time (R), coagulation time (K), and clot formation rate (α angle) between the two groups (P>0.05). CI, G and A were positively correlated with PT in GDM group (P<0.05), CI, MA, G and A were positively correlated with FIB in GDM group (P<0.05). Conclusion The blood of women with GDM is prone to form thrombosis, and the thrombus is not easy to fall off. The risk of bleeding in GDM women is also higher than that of normal pregnant women. The TEG indicators are significantly correlated with traditional coagulation indicators. TEG testing for GDM patients is superior to traditional coagulation function detection, which can accurately monitor the patients′ blood status, and provide a basis for clinical anticoagulation and hemostasis.