子痫前期双胎孕妇血小板参数及凝血功能指标变化的临床分析

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摘要目的通过比较子痫前期(PE) 和正常双胎孕妇在妊娠不同时期血小板参数及凝血功能指标变化情况,探讨上述指标在双胎妊娠不同时期的变化特点及在PE病情评估和发病预测方面的临床应用价值。方法选取2014年1月至2017年6月在北京大学第三医院产科住院分娩的370例双胎孕妇为研究对象,其中轻度子痫前期55例,重度子痫前期75例,正常双胎孕妇240例,回顾性分析三组孕妇在妊娠不同时期血小板参数[血小板计数(PLT)、血小板分布宽度(PDW)、血小板平均体积(MPV)、血小板压积(PCT)]及凝血功能指标[凝血酶时间(TT)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原含量(FIB)、D-二聚体(D-D)]的变化规律及临床意义。结果 ①凝血功能各指标中,从孕早期到孕中晚期,PT逐渐缩短,DD逐渐升高,各组内比较差异均有统计学意义(P<0.05)。孕晚期组间比较,重度PE组的FIB比其他两组均降低,重度PE组的TT比其他两组均升高,轻度PE组和重度PE组的DD及APTT均比正常组升高(P<0.05)。②血小板参数中,从孕早期到孕中晚期,PLT和PCT逐渐下降,MPV、PDW逐渐升高(P<0.05)。组间比较,孕晚期,PDW、MPV在轻度PE组和重度PE组均比正常组升高,PLT、PCT在重度PE组均比正常组下降(P<0.05)。③妊娠晚期做ROC曲线预测子痫前期,TT的AUC=67.5%,截断值=13.5s,OR=2.1,P<0.01;PDW的AUC=70.7%,截断值=13.5fL,OR=1.7,P<0.01。结论 ①子痫前期可能引发内外源性凝血系统的异常,血液异常高凝,动态监测凝血功能指标及血小板参数变化有助于了解病情发展,指导临床工作。②TT和PDW可能是早期预测双胎子痫前期发生的有效指标,若妊娠中晚期超过截断值,可起警示作用。

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	刘兆董
	赵扬玉
	魏瑗
	杨静

关键词 ：双胎妊娠, 子痫前期, 凝血功能, 血小板参数, 预测, 疾病严重程度

Abstract：Objective To compare the levels of platelet parameters and blood coagulation indices across different stages of pregnancy and between preeclampsia (PE) and normal twin pregnant women, and explore the values of these indicators with respect to predication and clinical management of PE . Methods A total of 370 twin pregnancies who gave birth in Peking University Third Hospital from January 2014 to June 2017 were included in this study, including 55 diagnosed as mild PE, 75 as severe PE, and 240 as normal twin pregnancy. Their platelet parameters including platelet count (PLT), platelet distribution width (PDW), mean platelet volume (MPV), and plateletcrit (PCT), and blood coagulation indices including thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen(FIB), and D-dimer (DD) were extracted from medical records, and differences in these indicators among the three groups at different stages of pregnancy were examined. Results ① In all the three groups of patients, the PT decreased and DD increased in the middle and late stage of pregnancy compared to the early stage (P<0.05). In the late pregnancy, the FIB was lower and TT was higher in severe PE group than the other two groups; the DD and APTT in the two PE groups were higher than those in the normal group (P<0.05). ② The PLT and PCT decreased and MPV and PDW increased in the middle and late stage of pregnancy compared to early pregnancy (P<0.05). In the late pregnancy, the PDW and MPV in the two PE groups were higher than those in the normal group (P<0.05), whereas the PLT and PCT in the severe PE group were lower than the normal group (P<0.05). ③ Among these indicators, the area under the curve (AUC) of the receiver-operating characteristic (ROC) curves were relatively higher for TT and PDW in the late pregnancy (67.5% and 70.7%, respectively), indicating good predictive performance of these two indicators for PE; the suggested cut-off value for TT was 13.5 s and for PDW was 13.5 fL. Conclusion ① PE may be associated with abnormal coagulation in both internal and external clotting system and with severe hypercoagulable state of the blood. Dynamic monitoring of the changes of platelet parameters and blood coagulation indices may be helpful in guiding clinical management of PE. ② TT and PDW are two potential indicators for early prediction of PE; it warrants close monitoring of occurrence of PE when the levels of these two indicators exceed the suggested cut-off value at middle and late pregnancy.

Key words： Twin pregnancy Preeclampsia Coagulation ability Platelet parameters Forecasting Severity of disease

收稿日期: 2018-11-26

基金资助:国家“生殖健康及重大出生缺陷防控研究”重点专项(2016YFC1000400,子课题2016YFC1000408)

通讯作者: 赵扬玉(zhaoyangyu001@163.com)

引用本文:

刘兆董, 赵扬玉, 魏瑗, 杨静. 子痫前期双胎孕妇血小板参数及凝血功能指标变化的临床分析[J]. 中国生育健康杂志, 2020, 31(3): 210-214.
LIU Zhaodong, ZHAO Yangyu, WEI Yuan, YANG Jing.. Clinical analysis of changes of platelet parameters and blood coagulation indices in twin pregnancy complicated with preeclampsia. Chinese Journal of Reproductive Health, 2020, 31(3): 210-214.

链接本文:

http://cjrh.bjmu.edu.cn/CN/ 或 http://cjrh.bjmu.edu.cn/CN/Y2020/V31/I3/210

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