妊娠期高血压疾病患者抗凝前后R、K、MA、α角变化及其预测预后的价值

Changes in R,K,MA,and α angles before and after anticoagulation in patients with hypertensive disorder of pregnancy and their value in predicting prognosis

目的探讨妊娠期高血压疾病(HDP)患者抗凝前后血凝块形成速率(K)、凝血反应时间(R)、最大振幅(MA)、α角变化及其预测预后的价值。方法选取2020年8月至2022年8月河北省秦皇岛市妇幼保健院153例HDP患者作为研究对象,以妊娠结局作为预后判定标准,分为预后良好组(n=124)、预后不良组(n=29),统计两组一般资料、R、K、MA、α角,采用Logistic分析HDP预后不良的影响因素,绘制受试者工作特征曲线(ROC)及曲线下面积(AUC)、决策曲线(DCA)、临床影响曲线(CIC)评价各指标单一及联合预测效能。结果两组年龄、发病孕周、24 h尿蛋白定量、病情程度、抗凝7 d后R、K、MA、α角比较,差异均有统计学意义(P<0.05);Logistic分析显示,发病孕周、年龄、病情程度、抗凝7 d后R、K、MA、α角是HDP患者预后不良的影响因素(P<0.05);ROC曲线显示,抗凝7 d后R、K、MA、α角联合预测HDP患者预后不良的AUC大于单一预测;DCA及CIC曲线显示,抗凝7 d后R、K、MA、α角模型预测HDP患者预后不良具有明显正向净收益率,且与实际情况符合率较高。结论HDP患者抗凝后R、K、MA、α角表达存在明显差异,以上指标预测HDP预后不良具有一定预测价值和临床适用性。

Objective To investigate the changes in clot formation rate(K),clotting reaction time(R),maximum amplitude(MA),αangle,and their prognostic value in patients with hypertensive disorder of pregnancy(HDP)before and after anticoagulation.Methods A total of 153 HDP patients from Maternity&Child Care Center of Qinhuangdao from August 2020 to August 2022 were selected as the study objects,and were divided into good prognosis group(n=124)and poor prognosis group(n=29)according to pregnancy outcome as the prognosis criterion.General data,R,K,MA,αangle of the two groups were analyzed.Logistic analysis was used to analyze the influencing factors of poor prognosis of HDP.Receiver operating characteristic curve(ROC),area under the curve(AUC),decision curve(DCA)and clinical impact curve(CIC)were plotted to evaluate the single and combined predictive efficacy of each indicator.Results There were statistically significant differences in age,gestational age at onset,24 hour urinary protein quantitation,disease severity,R,K,MA,andαangle after anticoagulation for 7 days between the two groups(P<0.05).Logistic analysis showed that gestational age at onset,age,disease severity,R,K,MA,andαangle after anticoagulation for 7 days were risk factors for poor prognosis in patients with HDP(P<0.05).ROC curve showed that the AUC of R,K,MA andαangle combined to predict poor prognosis of HDP patients was greater than that of single prediction after 7 days of anticoagulation.DCA and CIC curves showed that R,K,MA andαangle models predicted poor prognosis of HDP patients with a significant positive net return rate after 7 days of anticoagulation,and the coincidence rate was high with the actual situation.Conclusion There are significant differences in the expression of R,K,MA andαangle in patients with HDP after anticoagulation.The above indexes have certain predictive value and clinical applicability in predicting the poor prognosis of HDP.