凶险性前置胎盘患者妊娠期止血凝血功能特点及其对产后出血的预测价值

Characteristics of hemostasis and coagulation function during pregnancy in patients with pernicious placenta previa and its predictive value for postpartum hemorrhage

目的 探究凶险性前置胎盘(PPP)妊娠期止血凝血特点及其对PPP患者产后出血的预测价值。方法 选择2019年3月至2021年6月四川省自贡市妇幼保健院收治的76例PPP患者作为研究对象并纳入PPP组,另于同一时期选择50例健康孕妇纳入健康组。根据PPP组组内患者产后是否出血分为产后出血组(36例)和非产后出血组(40例)。比较PPP组和健康组孕妇的凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶时间(APTT)、纤维蛋白原(FIB)及D-二聚体(D-D)水平,分析PPP患者的止血凝血功能特点;多因素Logistic回归分析分析影响患者产后出血的独立影响因素;受试者操作特征(ROC)曲线分析凝血功能指标对PPP产妇产后出血的预测价值;构建并评价列线图预测模型。结果 PPP组PT、TT、APTT、FIB均明显高于正常组,D-D明显低于正常组(P<0.05)。PT、TT、APTT、FIB、D-D、胎盘粘连、胎盘植入、前置胎盘为可独立增加PPP患者产后出血风险(P<0.05)。PT、TT、APTT、FIB、D-D五者联合对PPP患者产后出血预测价值最好。列线图预测模型区分度较高,准确性和有效性较好。结论 PPP患者妊娠期的止血凝血功能较差,PT、TT、APTT、FIB、D-D与PPP患者产后出血有关,具有较高的预测价值与临床获益。

Objective To explore the hemostatic and coagulation characteristics of pernicious placenta previa(PPP)during pregnancy and its predictive value for postpartum hemorrhage in PPP patients. Methods 76 PPP patients admitted to Sichuan Zigong Hospital of Woman and Children Healthcare from September 2019 to December 2021 were selected as the research objects and included in the PPP group, in the same period, 50 healthy pregnant women were selected and included in the healthy group. According to whether the patients in PPP group have postpartum hemorrhage, they are divided into postpartum hemorrhage group(36 cases) and non postpartum hemorrhage group(40 cases). The levels of prothrombin time(PT),thrombin time(TT), activated partial thrombin time(APTT), fibrinogen(FIB) and D-Dimer(D-D) of pregnant women in PPP group and healthy group were compared, and the characteristics of hemostatic and coagulation function in PPP patients were analyzed. Multivariate logistic regression analysis was used to analyze the independent influencing factors of postpartum hemorrhage. Receiver operating characteristic curve(ROC) curve was used to analyze the predictive value of coagulation function indicators on postpartum hemorrhage in PPP mothers. Contructing and evaluating nomogram prediction model, Results PT, TT, APTT and FIB in PPP group were significantly higher than those in normal group, and D-D was significantly lower than that in normal group(P<0.05). PT, TT, APTT, FIB, D-D, placental adhesion, placenta accreta and placenta previa were independent influencing factors of postpartum hemorrhage in PPP patients(P<0.05). The combination of PT,TT, APTT, FIB and D-D have the best predictive value for postpartum hemorrhage in PPP patients. The nomograph model has high discrimination, accuracy and effectiveness. Conclusion The hemostatic and coagulation function of PPP patients during pregnancy is poor. PT, TT, APTT, FIB, D-D are related to postpartum hemorrhage in PPP patients, which has high predictive value and good clinical benefits.