血栓弹力图与常规凝血检测评估早期复发性流产患者凝血功能及指导抗凝治疗的预后比较

Comparison of thromboelastography and conventional coagulation tests in evaluating coagulation function and prognosis in guiding anticoagulation therapy in patients with early recurrent spontaneous abortion

目的探讨血栓弹力图(TEG)与常规凝血检测在评估复发性流产(RSA)患者孕早期凝血功能及指导抗凝治疗的临床价值,并探讨两种检测方法的相关性和一致性。方法选取2018年5月至2021年2月就诊于湘潭市中心医院生殖遗传中心和妇产科行抗凝治疗的孕早期RSA患者为研究对象,根据抗凝指导方法不同分为常规组(常规凝血功能检测指导组,64例)和TEG联合组(TEG联合常规凝血功能检测指导组,64例),比较两组患者的妊娠结局以及两种检测方法的相关性和一致性。结果TEG联合组患者妊娠成功率显著高于常规组(85.94%vs.64.06%,P<0.05),而早产率显著低于常规组(10.91%vs.29.27%,P<0.05)。相关性分析显示,TEG检测R值与常规检测PT、APTT正相关;K值与APTT正相关,与FIB负相关;Angle值与APTT负相关,与FIB正相关;MA值与FIB、PLT正相关,与APTT、TT负相关;CI值与APTT负相关,与FIB正相关;上述相关性的r值水平为0.250~0.442(P<0.05)。一致性分析仅显示TEG检测R值与PT以及MA值与PLT间存在一定一致性,Kappa值分别为0.116和0.285(P<0.05)。TEG诊断出血液高凝状态的阳性率显著高于常规凝血功能检测(70.31%vs.25.00%,P<0.001)。结论早孕RSA患者TEG与常规凝血功能检测结果存在低度相关性,但一致性较差;TEG诊断出血液高凝状态的阳性率较常规凝血功能检测更高,更适用于早孕RSA患者的血栓前状态筛查,且联合检测可进一步提高筛查阳性率;TEG联合常规凝血功能检测对优化抗凝治疗方案的指导作用更佳,可显著提高RSA患者的妊娠成功率并降低早产率。

Objective:To investigate the clinical value of thromboelastography(TEG)versus conventional coagulation tests in assessing coagulation function and guiding anticoagulation therapy in patients with early recurrent spontaneous abortion(RSA),and explore the correlation and concordance between the two assays.Methods:Patients with RSA in early pregnancy who attended the Reproductive Genetics Center and the Obstetrics and Gynecology Department of Xiangtan Central Hospital for anticoagulation from May 2018 to February 2021 were selected as the objects,and they were divided into conventional group(conventional coagulation tests group,n=64)and TEG combination group(TEG combined with conventional coagulation tests group,n=64)according to the different anticoagulation guidance methods,and the pregnancy outcomes of the two groups and the correlation and consistency of the two testing methods were compared.Results:The pregnancy success rate of patients in the TEG combination group was significantly higher than that of the conventional group(85.94%vs.64.06%,P<0.05),while the preterm delivery rate was significantly lower than that of the conventional group(10.91%vs.29.27%,P<0.05).Correlation analysis showed that R value of TEG test was positively correlated with conventional test PT and APTT,and K value was positively correlated with APTT and negatively correlated with FIB.Angle value was negatively correlated with APTT and positively correlated with FIB.MA value was positively correlated with FIB and PLT,and negatively correlated with APTT and TT.CI value was negatively correlated with APTT and positively correlated with FIB.r values of the above correlation levels were 0.250-0.442(P<0.05).Consistency analysis only showed some concordance between the R value of TEG test and PT,as well as between MA value of PLT,with kappa values of 0.116 and 0.285,respectively(P<0.05).The positive rate of hyper-coagulability diagnosed by TEG was significantly higher than that of conventional coagulation tests(70.31%vs.25.00%,P<0.001).Conclusions:There was a low correlation between TEG and conventional coagulation tests in patients with early pregnancy RSA,but the consistency was poor.The positive rate of blood hyper-coagulable state diagnosed by TEG is higher than that of conventional coagulation function test,which is more suitable for screening prethrombotic state in patients with early pregnancy RSA,and the combined test can further improve the positive screening rate.TEG combined with conventional coagulation tests provides better guidance for optimizing anticoagulation therapy,significantly improves pregnancy success and reduces preterm delivery rates in patients with early pregnancy RSA.