凝血功能联合胎儿脐血流监测在妊娠期高血压疾病中的价值研究

Value of coagulation function combined with fetal umbilical blood flow monitoring in hypertensive disorder complicating pregnancy

目的探讨凝血功能联合胎儿脐血流监测评估妊娠期高血压疾病(hypertensive disorder complicating pregnancy,HDCP)严重程度的临床参考价值,为HDCP的防治提供参考依据。方法选取2016年5月至2018年5月汕头市第三人民医院住院的159例HDCP患者及50例健康孕妇,进行回顾性研究。按照孕妇HDCP严重程度,将其分为妊娠期高血压组(64例,40.25%)、轻度子痫前期组(57例,35.85%)、重度子痫前期组(38例,23.90%),健康孕妇为对照组。比较4组孕妇凝血功能及胎儿脐动脉收缩压/舒张压(systolic blood pressure/diastolic blood pressure,S/D)比值,分析HDCP患者凝血功能及胎儿脐动脉S/D变化特点。结果对照组凝血酶原时间(prothrombin time,PT)、抗凝血酶Ⅲ(antithrombinⅢ,AT-Ⅲ)高于HDCP患者,活化部分凝原时间、纤维蛋白原(fibrinogen,FIB)、凝血酶时间(thrombin time,TT)低于HDCP患者;随着HDCP患者病情加重,其PT逐渐下降、FIB逐渐升高,组间比较差异有统计学意义(P<0.05)。对照组、妊娠期高血压组、轻度子痫前期组、重度子痫前期组胎儿脐动脉S/D比值及S/D异常率依次升高,组间比较差异有统计学意义(P<0.05)。Pearson相关性分析示,胎儿脐动脉S/D比值与孕妇PT呈负相关,与FIB呈正相关(P<0.05)。结论 HDCP的发生发展伴随着凝血功能与胎儿脐动脉S/D比值的显著变化,监测上述指标有望为HDCP的预测及预后评估提供可靠参考,从而指导临床干预方案与合理终止妊娠时机的选择。

Objective To explore the clinical value of coagulation function combined with fetal umbilical blood flow monitoring in evaluating the severity of hypertensive disorder complicating pregnancy(HDCP), and to provide reference for the prevention and treatment of HDCP. Methods 159 pregnant women with HDCP and 50 healthy pregnant women hospitalized in the Third People’s Hospital of Shantou from May 2016 to May 2018 were selected and prospective controlled study was carried out. According to the severity of HDCP in pregnant women, they were divided into pregnancy hypertension group(64 cases, 40.25 %), mild pre-eclampsia group(57 ceses,35.85 %), severe pre-eclampsia group(38 cases,23.90 %), and healthy pregnant women were included in the control group. The coagulation function of pregnant women and the ratio of fetal umbilical artery systolic blood pressure to diastolic blood pressure(S/D) were compared in four groups. Results PT and AT-III in control group were higher than those in pregnancy-induced hypertension group, mild pre-eclampsia group and severe pre-eclampsia group, and APTT, FIB and TT were lower than those in the latter. With the aggravation of HDCP, PT gradually decreased and FIB gradually increased, the differences between groups were statistically significant(P<0.05). The fetal umbilical artery S/D ratio and S/D abnormality rate in the control group, pregnancy induced hypertension group, mild pre-eclampsia group and severe pre-eclampsia group increased in turn, and the difference was statistically significant(P<0.05). Pearson correlation analysis showed that fetal umbilical artery S/D ratio was negatively correlated with PT and positively correlated with FIB(P<0.05). Conclusion The occurrence and development of HDCP are accompanied by significant changes of S/D ratio between coagulation function and fetal umbilical artery. Monitoring these indexes may provide reliable reference for the prediction and prognosis evaluation of HDCP, and guide the choice of clinical intervention and reasonable timing of termination of pregnancy.