子痫前期血栓弹力图与尿蛋白定量检测的临床意义及其对不良妊娠结局的预测价值

Clinical significance of thromboelastography and urine protein detection in preeclampsia and its value in predicting adverse pregnancy outcomes

目的探讨子痫前期(PE)孕妇血栓弹力图(TEG)联合尿蛋白定量检测的临床意义及其对不良妊娠结局的预测价值。方法回顾性收集2022年1月至2023年2月在该院建档并完成分娩的128例PE孕妇的临床资料,根据发病程度将其分为轻度PE组(98例)和重度PE组(30例),根据妊娠结局将其分为不良妊娠结局组(107例)和正常妊娠结局组(21例)。另收集该院同期孕周相匹配的健康孕妇95例作为对照组。分析各组孕妇TEG参数[包括反应时间(R值)、凝血时间(K值)、最大振幅(MA值)、α角、综合指数(CI值)]和尿蛋白定量检测的结果;采用Pearson相关分析PE孕妇尿蛋白定量与TEG参数的相关性及TEG参数和尿蛋白定量与不良妊娠结局的相关性;绘制受试者工作特征(ROC)曲线评估TEG相关参数和尿蛋白定量对不良妊娠结局的预测价值。结果重度PE组和轻度PE组的尿蛋白定量、α角、MA值和CI值均大于对照组,而R值和K值均小于对照组,差异均有统计学意义(P<0.05);重度PE组的R值小于轻度PE组,而CI值和MA值均大于轻度PE组,差异均有统计学意义(P<0.05);重度PE组和轻度PE组的K值、α角、尿蛋白定量比较,差异均无统计学意义(P>0.05)。Pearson相关性分析结果显示,PE孕妇尿蛋白定量与R值呈负相关(P<0.05),与MA值呈正相关(P<0.05)。不良妊娠结局组R值小于正常妊娠结局组,MA值、尿蛋白定量均大于正常妊娠结局组,差异均有统计学意义(P<0.05),但两组K值、α角、CI值比较,差异均无统计学意义(P>0.05)。ROC曲线分析结果显示,R值、MA值、尿蛋白预测PE组不良妊娠结局的曲线下面积(AUC)分别为0.803(95%CI:0.711~0.859)、0.799(95%CI:0.716~0.891)、0.812(95%CI:0.739~0.839),三项联合检测的AUC为0.949(95%CI:0.872~0.966)。结论TEG参数中的R值、MA值与尿蛋白定量三项联合检测对PE孕妇病情严重程度和不良妊娠结局有一定的预测价值,故临床应加强对妇女妊娠期间TEG参数中的R值、MA值和尿蛋白定量的检测。

Objective To investigate the clinical significance of thromboela stogram(TEG)combined with urine protein quantitation detection in pregnant women with preeclampsia(PE)and its predictive value of adverse pregnancy outcome.Methods The clinical data of 128 pregnant women with PE who were documented and completed delivery in the hospital from January 2022 to February 2023 were retrospectively collected,and divided into mild PE group(98 cases)and severe PE group(30 cases)according to the degree of morbidity;and adverse pregnancy outcome group(107 cases)and normal pregnancy outcome group(21 cases)according to the pregnancy outcome.At the same time,95 healthy pregnant women with matched gestational weeks in the same period of time in the hospital were collected as the control group.The results of TEG parameters including reaction time(R value),clotting time(K value),maximum amplitude(MA value),α-angle,composite index(CI value)and urine protein quantitation were analyzed in each group.Pearson correlation analysis was used to analyze the correlation between urine protein quantitation and TEG parameters of pregnant women with PE,as well as the correlation between TEG parameters and urine protein quantitation and adverse pregnancy outcome;Receiver operating characteristic(ROC)curves were drawn to assess the predictive value of TEG-related parameters and urine protein quantitation for adverse pregnancy outcome.Results The urine protein quantitation,αangle,MA value and CI value of the severe PE group and mild PE group were larger than those of the control group,while the R value and K value were smaller than those of the control group,and the differences were statistically significant(P<0.05);the R value of the severe PE group was smaller than that of the mild PE group,while the CI value and MA value were larger than those of the mild PE group,and the differences were statistically significant(P<0.05),but the differences of K value,αangle and urine protein quantitation between the severe PE group and the mild PE group were not statistically significant(P>0.05).Pearson's correlation analysis showed that urine protein quantitation in pregnant women with PE was negatively correlated with the R value(P<0.05),and positively correlated with the MA value(P<0.05).The R value of the adverse pregnancy outcome group was smaller than those of the normal pregnancy outcome group,and the MA value and urine protein quantitation were larger than that of the normal pregnancy outcome group,with statistically significant differences(P<0.05),but the differences of K value,α-angle and CI value between the two groups showed no statistical significance(P>0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of R value,MA value and urinary protein quantitation for predicting adverse pregnancy outcome in the PE group were 0.803(95%CI:0.711-0.859),0.799(95%CI:0.716-0.891)and 0.812(95%CI:0.739-0.839)respectively,and the AUC of the combined test of the above three indicators was 0.949(95%CI:0.872-0.966).Conclusion The R value and MA value of TEG parameters combined with urine protein quantitation have certain predictive value for the severity of the disease and adverse pregnancy outcome,so the clinic should strengthen the detection of R value,MA value and urine protein quantitation in TEG parameters during pregnancy in women.