不同程度胎盘早剥与凝血功能指标的相关性研究

Correlation between different degree of placental abruption and coagulation function index

目的探讨不同程度胎盘早剥与凝血功能指标的相关性。方法收集2019年1月至2021年9月期间深圳市坪山区人民医院接诊的72例胎盘早剥孕妇,作为观察组,年龄(28.67±3.05)岁,妊周(33.69±1.35)周,根据胎盘早剥严重程度分为轻型组(42例)与重型组(30例)。同期收集72例健康妊娠的孕妇作为参照组,年龄(28.56±3.11)岁,妊周(33.42±1.23)周。比较观察组与参照组的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)和纤维蛋白原(FIB)、D-二聚体(D-D)水平,比较轻型组与重型组凝血功能指标、不良妊娠结局,分析凝血指标预测不同程度胎盘早剥的效能。采用t检验、方差分析、χ^(2)检验进行统计分析,以受试者工作特征曲线(ROC)曲线下面积(AUC)评价预测效能。结果观察组PT(14.22±1.54)s、D-D(4.46±1.37)μg/L,均高于参照组[(9.11±0.45)s、(0.34±0.10)μg/L],差异均有统计学意义(t=27.026、25.450,均P<0.001);观察组FIB(3.46±0.42)g/L,低于参照组[(4.52±0.97)g/L],差异有统计学意义(t=8.509,P<0.001);观察组与参照组的APTT、TT水平比较,差异均无统计学意义(均P>0.05)。重型组D-D水平高于轻型组[(5.88±1.73)μg/L比(3.05±1.01)μg/L,t=8.734,P<0.001],FIB低于轻型组[(3.00±0.26)g/L比(3.93±0.59)g/L,t=8.079,P<0.001];轻型组与重型组的PT、APTT、TT水平比较,差异均无统计学意义(均P>0.05)。FIB、D-D预测轻重度胎盘早剥孕妇的AUC分别为0.630、0.609,而FIB联合D-D预测轻重度胎盘早剥的灵敏度为87.99%,特异度为86.59%,AUC为0.897,大于单一FIB、D-D的AUC,通过DeLong检验,联合预测的AUC与FIB、D-D的AUC比较,差异有统计学意义(Z=2.983、2.784,均P<0.001)。重型组胎盘早剥孕妇不良妊娠结局发生率高于轻型组胎盘早剥孕妇[70.00%(21/30)比30.95%(13/42)],差异有统计学意义(χ^(2)=30.501,P<0.001)。结论胎盘早剥母婴结局与胎盘早剥的严重程度密切相关,且胎盘早剥孕妇凝血功能指标中FIB下降、D-D升高与孕妇胎盘早剥的严重程度密切相关,FIB联合D-D预测胎盘早剥严重程度的效能佳。

Objective To explore the correlation between different degrees of placental abruption and coagulation function indicators.Methods Seventy-two pregnant women with placental abruption admitted to Pingshan District People's Hospital from January 2019 to September 2021 were collected as an observation group,with an age of(28.67±3.05)years and a gestation period of(33.69±1.35)weeks.According to the severity of placental abruption,they were divided into a mild group(42 cases)and a severe group(30 cases).During the same period,72 healthy pregnant women were collected as a reference group,with an age of(28.56±3.11)years and a gestation period of(33.42±1.23)weeks.The prothrombin times(PT),activated partial thromboplastin times(APTT),and thrombin times(TT)and levels of fibrinogen(FIB)and D-Dimer(D-D)were compared between the control group and the observation group.The coagulation function indicators and adverse pregnant outcomes were compared between the mild group and the severe group.The efficiencies of the coagulation indicators in predicting different degrees of placental abruption were analyzed.The t test,ANOVA,andχ^(2) test were used.The areas(AUC)under the receiver operating characteristic curves(ROC)were used to evaluate the prediction efficiencies.Results The PT and D-D levels in the observation group were higher than those in the reference group[(14.22±1.54)s vs.(9.11±0.45)s and(4.46±1.37)μg/L vs.(0.34±0.10)μg/L],with statistical differences(t=27.026 and 25.450,both P<0.001).The FIB level of the observation group was lower than that of the reference group[(3.46±0.42)g/L vs.(4.52±0.97)g/L],with a statistical difference(t=8.509,P<0.001).There were no statistical differences in APTT and TT between the observation group and the reference group(both P>0.05).The D-D level in the severe group was higher than that in the mild group[(5.88±1.73)μg/L vs.(3.05±1.01)μg/L],with a statistical difference(t=8.734,P<0.001);the FIB level in the severe group was lower than that in the mild group[(3.00±0.26)g/L vs.(3.93±0.59)g/L],with a statistical difference(t=8.079,P<0.001).There were no statistical differences in PT,APTT,and TT between the mild group and the severe group(all P>0.05).The AUC's of FIB and D-D in the prediction of mild and severe placental abruption were 0.630 and 0.609,respectively;the sensitivity and specificity of FIB combined with D-D in predicting mild and severe placental abruption were 87.99%and 86.59%,and the AUC was 0.897,which were better than FIB or D-D alone.By DeLong test,the AUC of the combined prediction was better than those of FIB and D-D,with statistical differences(Z=2.983 and 2.784,both P<0.001).The incidence of adverse pregnancy outcomes in the severe group was higher than that in the mild group[70.00%(21/30)vs.30.95%(13/42)],with a statistical difference(χ^(2)=30.501,P<0.001).Conclusions The maternal and fetal outcomes of placental abruption are closely related to the severity of placental abruption,and the decrease of FIB level and increase of D-D level in pregnant women with placental abruption are closely related to the severity of placental abruption.The combination of FIB and D-D is effective in predicting the severity of placental abruption.