妊娠合并不同程度血小板减少患者的凝血功能及母婴结局的比较

Coagulation function and maternal and neonatal outcomes among pregnant patients complicated with different degrees of thrombocytopenia:a comparative study

目的比较妊娠合并不同程度血小板减少患者的凝血功能及母婴结局。方法纳入530例妊娠合并血小板减少患者,根据分娩前血小板计数将患者分为轻度组338例、中度组145例及重度组47例,并选取100例健康孕产妇作为对照组。比较4组产妇分娩前血小板计数、凝血四项、血栓弹力检测指标及母婴结局。结果对照组、轻度组、中度组、重度组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)水平比较,差异均有统计学意义(均P<0.05),但随着血小板计数水平的降低,PT、APTT、TT并无逐渐延长的趋势,FIB水平也无逐渐降低的趋势;对照组、轻度组、中度组、重度组凝血酶形成时间依次升高,α角、血栓最大幅度和凝血指数均依次降低(均P<0.05)。中度组及重度组的剖宫产率均高于对照组,且轻度组、中度组及重度组的剖宫产率依次升高(均P<0.05);4组的产时出血量,以及早产、死胎、新生儿血小板减少、新生儿窒息的发生率比较,差异均无统计学意义(均P>0.05)。结论随着血小板减少程度加重,妊娠合并血小板减少患者的血栓弹力检测指标而非传统凝血功能指标可提示患者的凝血功能明显变化。妊娠合并血小板减少患者的剖宫产率随着血小板计数的减少而增加,但分娩方式应结合具体病情而决定。

Objective To compare the coagulation function and maternal and neonatal outcomes among pregnant patients complicated with different degrees of thrombocytopenia.Methods Totally 530 pregnant patients complicated with thrombocytopenia were enrolled and divided into mild group(n=338),moderate group(n=145)and severe group(n=47)according to the PLT count before delivery,and 100 healthy pregnant women were selected as control group.PLT count,four indices for coagulation,and thrombelastogram indices before delivery,and maternal and neonatal outcomes of pregnant women were compared among the four groups.Results There were statistically significant differences in prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),and fibrinogen(FIB)level among the control group,the mild group,the moderate group and the severe group(all P<0.05);however,with the decrease of PLT count level,PT,APTT or TT did not develop a tendency to prolong gradually,and FIB level did not have a tendency to decrease gradually;thrombinogenesis time increased,α angle,maximum thrombus amplitude and coagulation index decreased in the order of the control group,the mild group,the moderate group and the severe group(all P<0.05).The cesarean section rate was higher in the moderate and severe groups than in the control group,and increased in the mild,moderate and severe groups successively(all P<0.05);but no statistically significant difference was found among the four groups in blood loss during delivery,or incidence rate of premature delivery,stillbirth,neonatal thrombocytopenia or neonatal asphyxia(all P>0.05).Conclusion With the increasing thrombocytopenia severity,thrombelastogram indices other than traditional coagulation function indicators can indicate evident alteration of coagulation function in pregnant patients complicated with thrombocytopenia.The cesarean section rate rises with the decease of PLT count in pregnant patients complicated with thrombocytopenia,but the delivery mode should be determined in combination with specific conditions.