血栓弹力图参数与复发性流产患者妊娠结局的相关性分析及其临床价值研究

Correlation analysis of thromboelastogram parameters and pregnancy outcomes in patients with recurrent abortion and its clinical value

目的探讨血栓弹力图参数与复发性流产患者妊娠结局的相关性。方法选取2020年3月至2023年3月我院收治的103例(孕12周)复发性流产患者为观察组,同期103例(孕12周)健康体检孕妇为对照组,根据妊娠结局将复发性流产患者分为妊娠成功患者(n=66)和妊娠丢失患者(n=37)。比较两组入院时血栓弹力图参数[凝血反应时间(R值)、血凝块形成时间(K值)、凝血形成速率(Angle角)、最大振幅(MA值)、凝血指数(CI值)],比较不同妊娠结局患者入院时血栓弹力图参数,分析入院时血栓弹力图参数与复发性流产患者妊娠结局的相关性,logistic回归分析复发性流产患者妊娠丢失的影响因素,ROC分析入院时血栓弹力图参数联合检测对复发性流产患者妊娠丢失的预测价值。结果入院时观察组R值、K值较对照组显著降低,观察组Angle角、MA值、CI值较对照组显著升高,差异具有统计学意义(P<0.05);妊娠丢失患者入院时R值、K值显著低于妊娠成功患者,妊娠丢失患者Angle角、MA值、CI值较妊娠成功患者显著升高,差异具有统计学意义(P<0.05);入院时R值、K值与复发性流产患者妊娠结局呈负相关,Angle角、MA值、CI值与复发性流产患者妊娠结局呈正相关,差异具有统计学意义(P<0.05);经偏回归分析发现入院时R值、K值为复发性流产患者发生妊娠丢失的保护因素、Angle角、MA值、CI值为复发性流产患者发生妊娠丢失的危险因素,差异具有统计学意义(P<0.05);入院时R值、K值、Angle角、MA值、CI值联合预测复发性流产患者发生妊娠丢失的AUC为0.807。结论血栓弹力图参数与复发性流产患者妊娠结局密切相关,其水平检测有助于指导早期复发性流产患者进行抗血小板治疗,对改善患者妊娠结局具有重要意义。

Objective To investigate the correlation between thromboelastogram parameters and pregnancy outcomes in patients with recurrent abortion.Methods A total of 103 patients(12 weeks pregnant)with recurrent abortion admitted to our hospital from March 2020 to March 2023 were selected as the observation group,and 103 healthy pregnant women(12 weeks pregnant)during the same period were selected as the control group.According to the pregnancy outcome,the patients with recurrent abortion were divided into those with successful pregnancy(n=66)and those with pregnancy loss(n=37).The thromboelastogram parameters[coagulation reaction time(R value),blood clot formation time(K value),coagulation rate(Angle),maximum amplitude(MA value),and coagulation index(CI value)]of the two groups were compared at admission,and the thromboelastogram parameters of patients with different pregnancy outcomes were compared.The correlation between thrombalogram parameters at admission and pregnancy outcomes in patients with recurrent abortion was analyzed,the risk factors of pregnancy loss in patients with recurrent abortion were analyzed by partial regression,and the predictive value of thrombalogram parameters combined with detection in patients with recurrent abortion was analyzed by ROC.Results At admission,R value and K value of observation group were significantly lower than those of control group,and Angle value,MA value and CI value of observation group were significantly higher than those of control group,with statistical significance(P<0.05).The R value and K value of the patients with pregnancy loss were significantly lower than those with successful pregnancy,and the Angle,MA value and CI value of the patients with pregnancy loss were significantly higher than those with successful pregnancy(P<0.05).At admission,R value and K value were negatively correlated with the pregnancy outcome of patients with recurrent abortion,while Angle,MA value and CI value were positively correlated with the pregnancy outcome of patients with recurrent abortion,with statistical significance(P<0.05).By partial regression analysis,it was found that R value and K value at admission were protective factors for pregnancy loss in patients with recurrent abortion,and Angle,MA value and CI value were risk factors for pregnancy loss in patients with recurrent abortion,with statistical significance(P<0.05).The AUC of R value,K value,Angle value,MA value and CI value at admission to predict pregnancy loss in patients with recurrent abortion was 0.807.Conclusion The parameters of thromboelastogram are closely related to the pregnancy outcome of patients with recurrent abortion,and it is helpful to guide the antiplatelet therapy of patients with early recurrent abortion,which is of great significance for improving the pregnancy outcome of patients.