子宫腺肌病患者凝血功能的改变及其临床意义

Changes of coagulation function in patients with adenomyosis and its clinical significance

目的通过测定子宫腺肌病患者的凝血功能,探讨其与月经量增多的关系及临床意义。方法回顾性分析2014年1月至2019年5月在北京大学第一医院住院行子宫全切除术,术后病理检查证实为单纯子宫腺肌病患者111例(子宫腺肌病组)和子宫肌瘤患者115例(对照组)的临床资料,比较两组患者凝血功能的差异,并分析子宫腺肌病组凝血功能与子宫体积的相关性。结果(1)子宫腺肌病组患者的活化部分凝血活酶时间(APTT)较对照组明显延长[分别为(30.4±3.1)和(29.6±2.5)s;P<0.05],而凝血酶时间(TT)较对照组缩短[分别为(14.2±1.2)和(14.6±1.0)s;P<0.05]。子宫腺肌病组患者的子宫体积明显小于对照组,两组比较,差异有统计学意义[分别为(318±203)和(395±286)cm^3;P<0.05]。(2)子宫腺肌病组凝血酶原时间(PT;r=0.135,P=0.042)、纤维蛋白原定量(FIB-C;r=0.139,P=0.036)均与子宫体积呈正相关。(3)血小板计数在子宫腺肌病组贫血者中较非贫血者明显升高[分别为(323±79)×10^9/L和(274±56)×10^9/L;P<0.05]。(4)子宫腺肌病组非贫血者FIB-C明显低于对照组非贫血者[分别为(2.8±0.5)和(3.0±0.6)g/L;P<0.05];子宫腺肌病组贫血者较对照组贫血者TT明显缩短[分别为(14.4±1.2)和(15.2±0.9)s;P<0.05]。结论子宫腺肌病患者存在凝血功能异常,可能与其月经量增多有关,贫血也可能参与凝血功能紊乱。

Objective To measure the coagulation function of patients with adenomyosis so as to explore its relationship with increased menstrual amount and its clinical significance.Methods From January 2014 to May 2019,clinical data of patients with hysterectomy in which 111 pathologically diagnosed adenomyosis(case group)and 115 with uterine myoma(control group)in Peking University First Hospital were retrospectively analyzed.The changes in coagulation function of the two groups were compared,and the correlation between coagulation and uterine volume in the adenomyosis group was analyzed.Results(1)The activated partial thromboplastin time(APTT)was longer in the adenomyosis group than that in the uterine myoma group[(30.4±3.1),(29.6±2.5)s,respectively;P<0.05],while the thrombin time(TT)was shorter than that in the control group[(14.2±1.2),(14.6±1.0)s,respectively;P<0.05].(2)According to the results of the Pearson correlation test,there was a positive correlation between prothrombin time(PT;r=0.135,P=0.042)and fibrinogen(FIB-C;r=0.139,P=0.036).(3)Platelet counts were higher in the anemia group of adenomyosis than that in the non-anemia group[(323±79)×10^9/L,(274±56)×10^9/L,respectively;P<0.05].(4)FIB-C in non-anemia group of adenomyosis was lower than non-anemia group of uterine myoma[(2.8±0.5),(3.0±0.6)g/L,respectively;P<0.05],the anemia group of adenomyosis shortened TT compared with the anemia group of uterine myoma[(14.4±1.2),(15.2±0.9)s,respectively;P<0.05].Conclusion Patients with adenomyosis have abnormal coagulation function,which may be related to the increase amount of menstruation,and anemia may also be involved in coagulation disorders.