血栓弹力图在检测反复种植失败患者血栓前状态的应用

Application of thromboelastography in detecting prethrombotic status in patients with repeated implant failure

目的探究反复种植失败(RIF)患者在血栓弹力图(TEG)检测下对血栓前状态(PTS)的影响。方法回顾性分析120例于2021年3月-2023年9月期间来我院就诊的孕早期参检者的临床资料,依据患者病情分为病例组40例、对照组A40例、对照组B40例。分别于孕5-6周、孕9-10周,孕13-14周抽取空腹肘静脉血3ml,采用TEG分析仪测定TEG各项参数,孕酮、雌二醇(E2)、人绒毛促性腺激素(β-HCG)、D二聚体(D-D)水平。对比不同妊娠结局下患者血栓弹力图各指标水平、对比不同妊娠结局下性激素及凝血指标水平。结果120例孕早期参检者中至孕13-14周期间病例组出现流产24例,对照组A出现流产6例,对照组B出现流产4例,故将上述所有流产患者纳入流产组,共34例,继续妊娠86例纳入继续妊娠组,且病例组流产率高于对照组A及对照组B,有统计学差异(P<0.05)。继续妊娠组R值、α角及MA值均小于流产组,有统计学差异(P<0.05);两组K值比较,无统计学差异(P>0.05)。继续妊娠组E2、孕酮、β-HCG水平均高于流产组,D-D水平低于流产组,有统计学差异(P<0.05)。结论TEG在RIF患者PTS应用中能够动态监测患者各血液指标变化情况,并可于孕13-14周时对妊娠结局进行评判,尽早发现PTS,及时采取措施予以对症抗凝治疗,利于提高患者妊娠率,值得推广应用。

Objective To investigate the effect of repeated implant failure(RIF)patients on pre-thrombotic state(PTS)under thromboelastography(TEG)detection.Methods We retrospectively analysed the clinical data of 120 early pregnancy participants who attended our hospital from March 2021 to September 2023,and divided them into 40 cases in the case group,40 cases in the control group A,and 40 cases in the control group B according to the patients’conditions.Three ml of fasting elbow vein blood was drawn at 5-6 weeks,9-10 weeks,and 13-14 weeks of pregnancy respectively,and TEG parameters,progesterone,estradiol(E2),human chorionic gonadotropin(β-HCG),and D-dimer(D-D)levels were measured by TEG analyser.The levels of thromboelastography and sex hormones and coagulation indexes were compared between different pregnancy outcomes.Results Among the 120 early pregnancy participants,24 cases of miscarriage occurred in the case group,6 cases of miscarriage occurred in the control group A and 4 cases in the control group B during the period of 13-14 weeks’gestation.Therefore,all the above miscarriage patients were included in the miscarriage group with a total of 34 cases,and 86 cases of continuation of pregnancy were included in the continuation of pregnancy group,and the rate of miscarriage in the case group was higher than that in the control group A and the control group B,with a statistically significant difference(P<0.05).The R value,αangle and MA value of the continuing pregnancy group were smaller than those of the miscarriage group,with statistical differences(P<0.05);there was no statistical difference in the comparison of K values between the two groups(P>0.05).The levels of E2,progesterone andβ-HCG in the continuing pregnancy group were higher than those in the miscarriage group,and the levels of D-D were lower than those in the miscarriage group,with statistical significance(P<0.05).Conclusion TEG in RIF patients with PTS can dynamically monitor the changes of various blood indexes in patients,and can be used to judge the pregnancy outcome at 13-14 weeks of gestation,detect PTS as early as possible,and take timely measures to provide symptomatic anticoagulation,which is conducive to improving the pregnancy rate of patients,and is worthy of promotion and application.