小剂量阿司匹林对子痫前期高危患者血栓弹力图检测结果及sFlt-1/PLGF的影响

The effect of low-dose aspirin on the results of thromboelastography and sFlt-1/PLGF in high-risk patients with preeclampsia

目的探讨小剂量阿司匹林对子痫前期(PE)高危患者血栓弹力图(TEG)检测结果、可溶性血管内皮细胞生长因子受体1(sFlt-1)/胎盘生长因子(PLGF)的影响。方法选取2019年5月—2020年1月新疆医科大学第一附属医院产科收治孕12~16周有PE高危因素的孕妇30例作为观察组,同期选取孕12~16周正常孕妇30例作为对照组。观察组服用小剂量阿司匹林,至孕28周。比较2组TEG参数(R值、K值、MA值、α角)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)、纤维蛋白原(Fib)及血清sFlt-1、PLGF、sFlt-1/PLGF水平,分析观察组TEG参数与凝血四项指标关联性,比较2组不良妊娠结局。结果与入组时比较,观察组治疗后R值、K值、APTT、TT、PT、血清PLGF水平均升高,MA值、α角、Fib、血清sFlt-1、sFlt-1/PLGF水平均降低(t/P=4.582/<0.001、3.688/<0.001、3.631/<0.001、3.658/<0.001、4.219/<0.001、2.868/0.006、3.339/<0.001、3.782/0.001、3.784/<0.001、3.384/0.001、4.843/<0.001);2组孕28周时R值、K值、MA值、α角、APTT、TT、PT、Fib及血清sFlt-1、PLGF、sFlt-1/PLGF水平比较,差异均无统计学意义(P>0.05);观察组△APTT、△TT、△PT、△Fib、△R值、△K值、△MA值、△α角与△sFlt-1/PLGF均呈正相关(r/P=0.892/<0.001、0.788/<0.001、0.886/<0.001、0.864/<0.001、0.867/<0.001、0.877/<0.001、0.904/<0.001、0.893/<0.001);观察组治疗期间均未发生出血相关并发症,2组不良妊娠结局发生率比较,差异无统计学意义(P>0.05)。结论TEG与传统凝血四项指标均可准确反映PE高危患者血液高凝状态,小剂量阿司匹林可通过改善凝血功能,预防PE发生,改善妊娠结局,此过程可能与调节血清sFlt-1/PLGF表达有关。

Objective To explore the effects of low-dose aspirin on the results of thromboelastography(TEG)and soluble vascular endothelial growth factor receptor 1(sFlt-1)/placental growth factor(PLGF)in high-risk preeclampsia(PE)patients.Methods From May 2019 to January 2020,30 pregnant women with high risk factors for PE who were admitted to the Department of Obstetrics at the First Affiliated Hospital of Xinjiang Medical University from 12 to 16 weeks of pregnancy were selected as the observation group,and 30 normal pregnant women with 12 to 16 weeks of pregnancy were selected as the control group.The observation group took a small dose of aspirin until 28 weeks of pregnancy.Compare 2 groups of TEG parameters(R value,K value,MA value,α angle),activated partial thromboplastin time(APTT),thrombin time(TT),prothrombin time(PT),fibrinogen(Fib)And serum sFlt-1,PLGF,sFlt-1/PLGF levels,the correlation between the TEG parameters of the observation group and the four indexes of coagulation were analyzed,and the adverse pregnancy outcomes of the two groups were compared.Results Compared with the time of entry,the R value,K value,APTT,TT,PT,and serum PLGF levels of the observation group increased after treatment,and the MA value,αangle,Fib,serum sFlt-1,sFlt-1/PLGF levels decreased(t/P=4.582/<0.001,3.688/<0.001,3.631/<0.001,3.658/<0.001,4.219/<0.001,2.868/0.006,3.339/<0.001,3.782/0.001,3.784/<0.001,3.384/0.001,4.843/<0.001).There was no statistically significant difference between the two groups of R value,K value,MA value,αangle,APTT,TT,PT,Fib and serum sFlt-1,PLGF,sFlt-1/PLGF levels at 28 weeks of pregnancy(P>0.05).The observation group△APTT,△TT,△PT,△Fib,△R value,△K value,△MA value,△αangle and△sFlt-1/PLGF are all positively correlated(r/P=0.892/<0.001,0.788/<0.001,0.886/<0.001,0.864/<0.001,0.867/<0.001,0.877/<0.001,0.904/<0.001,0.893/<0.001).There were no bleeding-related complications in the observation group during treatment,and the difference in the incidence of adverse pregnancy outcomes between the two groups was not statistically significant(P>0.05).Conclusion The four indicators of TEG and traditional coagulation can accurately reflect the blood hypercoagulability status of high-risk PE patients.Low-dose aspirin can improve coagulation function,prevent the occurrence of PE,and improve pregnancy outcome.This process may be related to the regulation of serum sFlt-1/PLGF expression.