重度子痫前期并发HELLP综合征患者凝血功能指标变化及临床意义

Changes and Clinical Significance of Coagulation Function in Severe Preeclamps Complicated with HELLP Syndrome

【目的】分析重度子痫前期(SPE)并发HELLP综合征患者凝血功能指标变化及临床意义。【方法】选取2018年1月至2022年12月本院收治的98例SPE患者,根据患者住院期间是否会并发HELLP综合征分为A组(并发HELLP综合征,n=30)和B组(未并发HELLP综合征,n=68),比较两组入院时凝血指标[纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原降解产物(FDP)、D二聚体(D-D)]、白介素(IL-6)、C反应蛋白(CRP),采用多因素Logistic回归分析SPE并发HELLP综合征的影响因素。【结果】两组产妇类型、年龄、孕周、体重、呼吸频率(RR)、收缩压(SBP)、舒张压(DBP)、心率(HR)、平均动脉压(MAP)、肌酐(Scr)、血尿素氮(BUN)比较,差异无统计学意义(P>0.05);A组患者PT、APTT均长于B组,D-D、FDP、IL-6、CRP水平均高于B组,FIB水平、红细胞计数(RBC)低于B组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:PT、APTT、D-D、FDP、FIB、RBC均是SPE患者并发HELLP综合征的影响因素(P<0.05)。【结论】临床可监测SPE患者并发HELLP综合征RBC、PT、APTT、FIB、D-D、FDP变化,为临床医生评估SPE并发HELLP综合征患者病情、疗效及预后提供参考。

【Objective】To analyze the changes of coagulation function and its clinical significance in patients with severe preeclampsia(SPE)complicated with HELLP syndrome.【Methods】Ninety-eight SPE patients admitted to our hospital from January 2018 to December 2022 were selected and divided into group A(with HELLP syndrome,n=30)and group B(without HELLP syndrome,n=68)according to whether the patients would develop HELLP syndrome during hospitalization.Coagulation indexes[fibrinogen(FIB),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen degradation product(FDP),D-dimer(D-D)],interleukin(IL-6)and C-reactive protein(CRP)were compared between the two groups at admission.Multiple Logistic regression was used to analyze the influencing factors of SPE complicated with HELLP syndrome.【Results】There were no significant differences in pregnant type,age,gestational week,body weight,respiratory rate(RR),systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),mean arterial pressure(MAP),creatinine(Scr)and blood urea nitrogen(BUN)between the two groups(P>0.05).The PT and APTT measurements in group A were longer than those in group B,the levels of D-D,FDP,IL-6 and CRP were higher than those in group B,and the levels of FIB and red blood cell(RBC)count were lower than those in group B,with statistical significance(P<0.05).Multivariate Logistic regression analysis showed that PT,APTT,D-D,FDP,FIB and RBC were the influencing factors of HELLP syndrome in SPE patients(P<0.05).【Conclusion】Abnormal RBC,PT,APTT,FIB,D-D and FDP are risk factors for HELLP syndrome in SPE patients.Monitoring the changes of the above indexes can provide references for clinicians to evaluate the condition,efficacy and prognosis of SPE patients with HELLP syndrome.