血栓弹力图参数在预测妊娠合并血小板减少症患者母婴结局中的应用价值

Value of thromboelastography parameters applied to predicting maternal and neonatal outcomes in pregnant patients complicated with thrombocytopenia

目的探讨血栓弹力图(TEG)参数在预测妊娠合并血小板减少症患者母婴结局中的应用价值。方法选取172例妊娠合并血小板减少症患者,进行TEG参数检测。随访至分娩结束,记录母婴不良结局发生情况。采用受试者工作特征曲线分析TEG参数预测妊娠合并血小板减少症患者母体不良结局和围产儿不良结局的效能。结果 172例妊娠合并血小板减少症患者的母体不良结局、围产儿不良结局发生率分别为11.63%(20/172)、12.79%(22/172)。母体或围产儿结局不良者的凝血反应时间(R)、血凝块形成时间(K)均长于结局良好者,凝固角(α)、最大振幅(MA)、凝血综合指数(CI)均小于或低于结局良好者(均P<0.05)。R、K、α、MA、CI单独预测母体结局不良和围产儿结局不良的曲线下面积均在0.689~0.792之间,特异度均在78.67%~81.58%之间,而5个指标联合预测母体结局不良和围产儿结局不良时的曲线下面积均大于0.850、特异度均在95%以上,均大于上述单一指标(均P<0.05)。结论 TEG参数R、K、α、MA、CI在预测妊娠合并血小板减少症患者的母体和围产儿不良结局中均具有一定的价值,但联合上述TEG参数进行预测的效能最优。

Objective To explore the value of thromboelastography(TEG) parameters applied to predicting maternal and neonatal outcomes in pregnant patients complicated with thrombocytopenia.Methods Totally 172 pregnant patients complicated with thrombocytopenia were selected,and all received TEG parameters detections.The follow-up lasted until delivery,and the incidence of maternal and neonatal adverse outcomes was recorded.Receiver operating characteristic curve was used to analyze the efficiency of TEG parameters for predicting maternal and perinatal adverse outcomes in patients with pregnancy complicated with thrombocytopenia.Results Among the 172 patients with pregnancy complicated with thrombocytopenia,the incidence rates of maternal and perinatal adverse outcomes were 11.63%(20/172) and 12.79%(22/172),respectively.By comparison with patients with favorable outcomes,patients with maternal or perinatal adverse outcomes had increased coagulation reaction time(R) and clotting time(K),and decreased coagulation angle(α),maximum amplitude(MA),and coagulation index(CI)(all P<0.05).For predicting maternal and perinatal adverse outcomes,R,K,α,MA,and CI yielded areas under the curve(AUC) between 0.689 and 0.792 and specificities between 78.67% and 81.58%,the combination of these five indexes obtained an AUC larger than 0.850 and a specificity above 95%,presenting increases in AUC and specificity as compared with single index described above(all P<0.05).Conclusion TEG parameters,R,K,α,MA,and CI,have a certain values in evaluating maternal and perinatal adverse outcomes in patients with pregnancy complicated with thrombocytopenia,whereas the combination of the aforementioned TEG parameters achieves optimum predictive efficiency.