妊娠期血小板减少症患者分娩前后凝血功能分析

Coagulation function of patients with gestational thrombocytopenia before and after delivery

目的探讨妊娠期血小板减少症(gestational thrombocytopenia,GT)患者凝血功能的动态变化情况。方法选择2019年10月至2022年6月建卡并定期产检的GT患者55例为观察组,选取同一时期产检及分娩的正常孕妇60例为对照组。采用全自动凝血分析仪检测的凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)和D-二聚体(DD)水平;采用全自动血液细胞分析仪检测血小板计数(PLT)、血小板压积(PCT)、平均血小板体积(MPV)、血小板分布宽度(PDW)。采用t检验比较并分析观察组与对照组妊娠晚期凝血功能的差异,以及GT患者分娩前后凝血功能动态变化情况。结果分娩前,观察组的PLT、PCT明显低于对照组,MPV、PDW明显高于对照组,差异均有统计学意义(t值分别为-18.184、-17.277、3.083、3.671,P<0.05);分娩前,观察组的PT明显短于对照组、FIB明显低于对照组、DD明显高于对照组,差异均有统计学意义(t值分别为-3.560、-3.331、3.412,P<0.05);两组的APTT、TT比较差异均无统计学意义(P>0.05)。GT患者分娩前的PLT明显低于分娩后,差异有统计学意义(t=-3.535,P<0.05);GT患者分娩前与分娩后的PCT、MPV、PDW比较差异均无统计学意义(P>0.05)。GT患者分娩前的PT和APTT均明显短于分娩后,DD明显低于分娩后,差异均有统计学意义(t值分别为-3.673、-2.457、-2.826,P<0.05);GT患者分娩前的TT、FIB与分娩后比较差异均无统计学意义(P>0.05)。结论产后GT患者PT延长、APTT延长、DD升高,PLT增高,提示GT患者仍有发生产后出血及静脉血栓栓塞症(VTE)的可能,因此对GT患者的凝血功能动态评估可提供产后出血和VTE有效预防的参考。

Objective To investigate the dynamic changes of coagulation function in gestational thrombo⁃cytopenia(GT)patients.Methods A total of 55 GT patients who had registered in our hospital from October 2019 to June 2022 and had regular obstetric check⁃ups were enrolled into observation group,and 60 normal preg⁃nant woman were selected as the control group.The level of PT,APTT,TT,FIB and DD were detected by automatic coagulation analyzer.PLT,PCT,MPV and PDW were measured by automatic blood cell analyzer.T test was used to compare the differences of coagulation function between GT patients and normal pregnant women in the third trimester of pregnancy,and the dynamic changes of coagulation function before and after delivery in GT patients.Results Prenatal PLT and PCT were lower,while MPV and PDW higher in the observation group than those in the control group,showing statistical significance(t=-18.184,-17.277,3.083,and 3.671 respectively,P<0.05).Prenatal PT in the observation group was significantly shorter;FIB significantly lower,while DD significantly higher than those in the control group and the differences were statistically significant(t=-3.560,-3.331 and 3.412 respectively,P<0.05).There was no significantdifference between prenatal APTT and TT in the two groups(P>0.05).After delivery,PLT in GT patients were significantly elevated,indicating statistical significance(P<0.05);there was no significant differenceinMPV,PDWand PCT in GT patients before and after delivery(P>0.05).PT and APTT in GT patients after delivery were prolonged,while DD increased and the differences were statistically significant(P<0.05);there was no significant difference in TT and FIB in GT patients before and after delivery(P>0.05).Conclusion Prolonged PT and APTT,and elevated DD and PLT in postpartum GT patients suggest that postpartum hemorrhage and venous thromboembolism(VTE)are still possiblein GTpatients.Therefore,dynamic evaluation of coagulation function in GT patients provides reference for the effective prevention of postpartum hemorrhage and VTE.