子痫前期-子痫孕妇凝血功能指标与胎盘早剥的关联分析

Association between coagulation function indicators and placental abruption among preeclampsia-eclampsia pregnant women

目的:探讨子痫前期-子痫孕妇不同妊娠阶段凝血功能指标与胎盘早剥(PA)的关联。方法:选择2018年2月至2020年12月在首都医科大学附属北京妇产医院参加“中国出生人口队列研究”且被诊断为子痫前期、子痫、慢性高血压伴发子痫前期的孕妇为研究对象。采用问卷调查收集基线和随访信息,通过医院病例系统获取孕早期和晚期的凝血功能指标。采用Cox比例风险回归模型,分析不同妊娠阶段凝血功能指标与PA发生的关联;采用限制性立方样条曲线,分析相关凝血功能指标与PA发生的剂量反应关系。结果:共纳入研究对象1340例,年龄(32.50±4.24)岁,PA发生率为4.4%(59/1340)。调整相关因素后,Cox比例风险回归模型分析显示,与纤维蛋白原(FIB)高水平组相比,孕早期中等水平(HR=3.28,95%CI:1.27~8.48)和低水平组(HR=3.84,95%CI:1.40~10.53)及孕晚期低水平组(HR=4.18,95%CI:1.68~10.39)PA发生风险均显著增加;与孕晚期凝血酶原时间(PT)中等水平组相比,低水平组(HR=2.67,95%CI:1.48~4.82)PA发生风险显著增高。限制性立方样条分析显示,孕早期和晚期的FIB与PA呈线性负相关,PT与PA呈近似“L”型相关。结论:子痫前期-子痫孕妇孕早期和晚期中低水平的FIB,以及孕晚期低水平的PT增加了PA发生的风险。

Objective To explore the association between coagulation function indicators and placental abruption(PA)in different trimesters of pregnancy among preeclampsia-eclampsia pregnant women.Methods From February 2018 to December 2020,pregnant women who participated in the China birth cohort study and were diagnosed with preeclampsia,eclampsia and chronic hypertension with superimposed preeclampsia in Beijing Obstetrics and Gynecology Hospital were enrolled in this study.The baseline and follow-up information were collected by questionnaire survey,and the coagulation function indicators in the first and third trimesters were obtained through medical records.The Cox proportional hazards model was used to analyze the association between the coagulation function indicators and PA.A restrictive cubic spline curve was used to draw the dose-response curve between the relevant coagulation function indicators and PA.Results A total of 1340 participants were included in this study.The age was(32.50±4.24)and the incidence of PA was 4.4%(59/1340).After adjusting for relevant factors,Cox proportional hazards model showed that compared with the high-level classification of fibrinogen(FIB),participants within the middle-(HR=3.28,95%CI:1.27-8.48)and low-level(HR=3.84,95%CI:1.40-10.53)classification during the first trimester and within the low-level classification(HR=4.18,95%CI:1.68-10.39)during the third trimester were more likely to experience PA.Compared with the middle-level classification of pro-thrombin time(PT),the risk of PA in the participants within the low-level classification(HR=2.67,95%CI:1.48-4.82)was significantly higher in the third trimester.The restrictive cubic spline analysis showed a linear negative association between FIB and PA in the first and third trimesters,while PT and PA showed an approximately L-shaped association.Conclusion Among pregnant women diagnosed with preeclampsia-eclampsia,the middle-and low-level classification of FIB in the first and third trimesters and the low-level classification of PT in the third trimester could increase the risk of PA.