血栓弹力图监测在妊娠合并血小板减少症孕妇凝血功能评估中的应用

Application of thromboelastography monitoring in the evaluation of coagulation function of pregnant women with pregnancy-associated thrombocytopenia

目的:探究血栓弹力图监测(TEG)在妊娠合并血小板减少症(PAT)患者中的评估作用。方法:回顾性分析80例因PAT接受治疗的孕晚期患者临床资料,设置为PAT组,并选取同期健康孕晚期孕妇74例设为对照组,比较两组凝血功能[凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)]、TEG指标[凝血酶形成时间(K)、血小板功能(MA)、凝血综合指数(CI)]差异,分析PAT不同疾病程度患者TEG指标差异,比较PAT不同分娩方式患者凝血功能指标与TEG指标差异,使用受试者工作特征(ROC)曲线分析TEG对PAT的诊断效能。结果:两组患者PT、APTT、TT、FIB等凝血功能指标比较差异不具有统计学意义(P>0.05),而K值、MA值、CI值等TEG指标比较差异具有统计学意义(P<0.05);随着PAT疾病严重程度加重,K值依次上升,MA值、CI值依次下降,且组间两两比较差异具有统计学意义(P<0.05);阴道分娩组K值低于剖宫产组,MA值、CI值高于剖宫产组,差异具有统计学意义(P<0.05);K值、MA值、CI值诊断孕妇发生PAT的灵敏度分别为50.00%、79.73%、79.84,特异性分别为92.50%、67.50%、92.53%;联合预测灵敏度为95.95%,85.00%。结论:TEG对孕妇发生是否发生PAT具有良好评估价值,可与传统凝血功能检查指标联合使用,帮助医生为PAT患者选择更为合适的分娩方式。

Objective:To explore the evaluated effects of thromboelastography monitoring(TEG)on patients with pregnancyassociated thrombocytopenia(PAT).Methods:The clinical data of 80 patients in last trimester who received PAT treatment were retrospectively analyzed,and the patients were set as PAT group,and 74 healthy pregnant women in last trimester during the same period were set as control group.The coagulation function[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB)]and TEG indexes[thrombin formation time(K),platelet function(MA),coagulation index(CI)]were compared between the two groups,and the differences of TEG indexes were analyzed among PAT patients with different disease degrees,and the differences of coagulation function indexes and TEG indexes were compared among PAT patients with different delivery methods,and and receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of TEG on PAT.Results:There were no statistically significant differences in the coagulation function indexes such as PT,APTT,TT,and FIB between the two groups(P>0.05),while there were statistically significant differences in the K value,MA value,CI value and other TEG indexes(P<0.05).As the severity of PAT worsened,the K value was increased in sequence while the MA value and CI value were decreased in sequence,and the differences in the any two between groups were statistically significant(P<0.05).The K value in vaginal delivery group was lower than that in cesarean section group while the MA value and CI value were higher than those in cesarean section group(P<0.05).The sensitivities of K value,MA value and CI value in diagnosing PAT in pregnant women were 50.00%,79.73%,and 79.84%,and the specificities were 92.50%,67.50%,and 92.53%respectively.The sensitivities ofcombined prediction were 95.95%and 85.00%.Conclusion:TEG has a good evaluated value for whether PAT occurs in pregnant women.It can be used in conjunction with indexes of traditional coagulation function testand can help doctors to choose a more suitable delivery method for PAT patients.