血栓弹力图预测早期流产及指导抗凝治疗的临床价值

Clinical Study on thromboelastography in predicting early abortion and guiding anticoagulation therapy

目的探讨血栓弹力图对早期流产的预测作用,并分析其对抗凝治疗的指导作用。方法选取2018年4月至2019年2月湖南省湘潭市中心医院妇产科诊治的162例有反复流产史/胚胎停育史的孕妇资料进行回顾性分析。均定期接受血栓弹力图检测,追踪至孕16周,记为研究组;另回顾同时间段的565例正常健康孕妇资料,记为对照组。统计流产发生率,对比两组孕妇血栓弹力图指标;对比不同时刻流产者和未流产者血栓弹力图指标,分析其对早期流产的预测效能。对比监测期间出现高凝状态的孕妇接受治疗前后血栓弹力图指标变化。结果研究组孕妇孕8周~12周、孕12周~16周、>孕16周流产发生率和总发生率均高于对照组(均P<0.05);研究组孕妇基线R值、K值均低于对照组(均P<0.05),Angel角、MA值、CI值均高于对照组(均P<0.05);研究组流产者基线R值、K值均短于未流产者(均P<0.05),Angel角、MA值、CI值均高于未流产者(均P<0.05);基线血栓弹力图指标联合预测早期流产的灵敏度、特异度、AUC分别为96.30%、96.30%、0.913,均高于各项指标单独预测,且R值、K值、Angel角、MA值、CI值预测早期流产的最佳截断点分别为5.95min、1.05min、83.15°、71.50mm、4.35;研究组孕妇中出现高凝状态者治疗后R值、K值均升高,Angel角、MA值、CI值均降低(均P<0.05)。结论有反复流产史/胚胎停育史的孕妇早期流产风险高,血栓弹力图指标有异常,且流产者均有明显异常,血栓弹力图指标对流产的预测效能高,还可指导抗凝治疗。

Objective To explore the predictive effect of thromboelastography on early abortion and to analyze its guiding role in anticoagulation therapy.Methods The data of 162 pregnant women with history of repeated abortion/embryo sterilization and compliance with inclusion and exclusion criteria were retrospectively analyzed.All of them,as the study group,were regularly tested by thromboelastogram and tracked to 16 weeks of gestation.The data of 565 healthy pregnant women in the same period,as control group,were also reviewed.The incidences of abortion was counted and the thromboelastogram indicators were compared between the two groups.Thromboelastogram indexes of abortion and non-abortion at different time were compared,and its predictive effect on early abortion was analyzed.The changes of thromboelastogram in patients with hypercoagulability during monitoring were compared before and after treatment.Results The incidence of abortion at 8~12 weeks of pregnancy,12~16 weeks of pregnancy,and 16 weeks of>pregnancy in the study group were higher than those in the control group(all P<0.05).The baseline R and K values of pregnant women in the study group were lower than those in the control group(all P<0.05),and the Angel Angle,MA and CI values were higher than those in the control group(all P<0.05).The baseline R and K values of abortion patients were shorter than those of non-abortion patients(all P<0.05),and Angel Angle,MA and CI values were higher than those of non-abortion patients(all P<0.05).The sensitivity,specificity and AUC of the baseline thromboelastic graph combined with the prediction of early abortion were 96.30%,96.30%and 0.913,respectively,which were all higher than the prediction by each single indicator.Moreover,the optimal cutoff points of R value,K value,Angel Angle value,MA value and CI value were 5.95min,1.05min,83.15°,71.50mm and 4.35,respectively.In the study group,R and K values were all increased after treatment,while Angel Angle,MA and CI values were all decreased(all P<0.05).Conclusions Pregnant women with a history of repeated abortion/embryo cessation have high a risk of early abortion,abnormal thromboelastogram indicators,and obvious abnormalities in abortion.Thromboelastogram indicators are highly effective in predicting abortion,and can also guide anticoagulation therapy.