孕早期PLGF和TEG对妊娠期高血压诊断及妊娠结局预测的价值

Value of early pregnancy PLGF and TEG in diagnosing pregnancy-induced hypertension and predicting pregnancy outcomes

目的探讨孕早期胎盘生长因子(PLGF)、血栓弹力图(TEG)对妊娠期高血压患者疾病诊断及妊娠结局预测的价值。方法回顾性选取2021年1月至2023年2月榆林市中医医院确诊为妊娠期高血压患者70例,作为观察组,产前检查健康孕妇20例作为对照[C组,年龄(32.39±4.96)岁,孕周(35.44±4.87)周]。将观察组分为单纯妊娠期高血压组[H组24例,年龄(34.18±5.73)岁,孕周(35.46±4.83)周]、轻度子痫前期组[Q组22例,年龄(33.46±5.08)岁,孕周(35.13±5.11)周]、重度子痫前期组[Z组24例,年龄(34.27±5.88)岁,孕周(35.36±4.95)周],根据妊娠结局分为不良妊娠组与妊娠结局良好组。检查并比较孕妇PLGF水平和TEG参数[凝血反应时间(R)、血细胞凝集成形时间(K)、血细胞凝集块形成速率(α角)、凝血块最大振幅(MA)、综合凝血指数(CI)]的差异,评估PLGF水平和TEG参数在预测妊娠结局中的有效性。采用方差分析、t检验、χ2检验进行统计比较。结果C组PLGF[(293.77±104.38)ng/L]、R[(4.36±0.66)min]最大,Q组低于H组,Z组[PLGF(62.57±13.72)ng/L、R(2.34±0.21)min]最小,C组α角[(64.37±5.44)°]、MA[(59.88±6.92)mm]和CI[(2.41±0.57)]最小,Q组高于H组,Z组最大[α角(75.33±8.47)°、MA(77.41±9.84)mm和CI(4.31±1.43)],4组比较差异均有统计学意义(F_(PLGF)=67.926,F_(R)=59.942,F_(α)=8.587,F_(MA)=18.685,FCI=14.828,均P<0.05);4组K值差异无统计学意义(F=1.944,P=0.128)。4组不良妊娠率比较[C组为5.00%(1/20),H组为12.50%(3/24),Q组为36.36%(8/22),Z组为54.17%(13/24)],差异有统计学意义(χ^(2)=18.117,P<0.001)。70例妊娠期高血压患者不良妊娠24例,良好妊娠46例,不良妊娠结局组与妊娠结局良好组孕妇年龄、妊娠期高血压类型、PLGF、R、MA、CI比较差异均有统计学意义(均P<0.05),K、α角差异均无统计学意义(均P>0.05)。相关性分析显示,妊娠期高血压疾病严重程度、不良妊娠结局与PLGF水平(r=-0.494、-0.471,均P<0.05)及TEG参数中的R值(r=-0.439、-0.408,均P<0.05)呈负相关,与TEG参数中的MA值(r=0.414、0.308,均P<0.05)和CI值(r=0.429、0.310,均P<0.05)呈正相关。结论孕早期PLGF和TEG可作为妊娠期高血压患者的重要诊断工具,有助于早期识别高风险妊娠,为临床提供更有效的管理和治疗策略。

Objective To investigate the diagnostic and prognostic value of placental growth factor(PLGF)and thromboelastography(TEG)in early pregnancy for patients with hypertensive disorders of pregnancy(HDP).Methods A retrospective analysis was conducted.Seventy pregnant patients diagnosed with hypertension during pregnancy from January 2021 to February 2023 at Yulin Hospital of Traditional Chinese Medicine were selected as an observation group.Twenty healthy pregnant women undergoing prenatal examinations were selected as a control group(group C);they were(32.39±4.96)years old;their gestational weeks were(35.44±4.87)weeks.The observation group was subdivided into a gestational hypertension group[group H;24 cases,they were(34.18±5.73)years old;their gestational weeks were(35.46±4.83)weeks],a mild preeclampsia group[group Q;22 cases,they were(33.46±5.08)years old;their gestational weeks were(35.13±5.11)weeks],and a severe preeclampsia group[group Z;24 cases,they were(34.27±5.88)years old;their gestational weeks were(35.36±4.95)weeks].The patients were categorized into groups with and without adverse pregnancy outcomes based on their pregnancy outcomes.The study examined and compared the levels of PLGF and TEG parameters between these groups to assess the effectiveness of PLGF and TEG parameters in predicting pregnancy outcomes.Analysis of variance,t test,and χ^(2) test were applied.Results In the study,the highest level of PLGF[(293.77±104.38)ng/L]and R value[(4.36±0.66)min]were observed in group C;the levels in group Q were lower than those in group H;the levels in group Z were the lowest[(62.57±13.72) ng/L and(2.34±0.21)min].Theα-angle,MA,and CI in group C were the smallest[(64.37±5.44)°,(59.88±6.92)mm,and(2.41±0.57)];those in group Q were higher than those in group H;those in group Z were the largest[(75.33±8.47)°,(77.41±9.84)mm,and(4.31±1.43)].There were statistical differences between the 4 groups(FPLGF=67.926,FR=59.942,Fα=8.587,FMA=18.685,and FCI=14.828;all P<0.05).There was no statistical difference in K value between group C,group H,group Q,and group Z(F=1.944,P=0.128).There was a statistical difference in the rate of adverse pregnancy outcomes between group C,group H,group Q,and group Z[5.00%(1/20)vs.12.50%(3/24)vs.36.36%(8/22)vs.54.17%(13/24);χ^(2)=18.117,P<0.001].Among the 70 patients,24 had adverse pregnancy outcomes and 46 had good outcomes;there were statistical differences in maternal age,types of hypertension during pregnancy,PLGF,R,MA,and CI(all P<0.05),but no in K orα-angle(both P>0.05)between the two groups.Correlation analysis indicated negative association of the severity of hypertension during pregnancy and adverse pregnancy outcomes with PLGF(r=-0.494 and-0.471;both P<0.05),TEG parameter R value(r=-0.439 and-0.408;both P<0.05),and a positive correlation with MA(r=0.414 and 0.308,P<0.05),and CI value(r=0.429 and 0.310;both P<0.05).Conclusion Early pregnancy PLGF and TEG may serve as crucial diagnostic tools for patients with hypertension during pregnancy,and are conducive to the early identification of high-risk pregnancies and providing more effective management and treatment strategies clinically.