子痫前期患者血栓弹力图变化...与母婴并发症发生的关系分析_任丽萍.pdf

14魏鸿，贺丹，许航.年龄、孕前体质指数、孕早期空腹血糖和糖化血红蛋白在妊娠期糖尿病预测中的价值 J 实用医院临床杂志，2021，18(6):110114.15He H，Liu Y，Sun M.Nesfatin 1 alleviates high glucose/highlipidinduced injury of trophoblast cells during gestational diabetesmellitus J Bioengineered，2021，12(2):1278912799.16陈曼丽，范琳，石文焕，等.老年初诊 2 型糖尿病病人血清淀粉样蛋白 A、摄食抑制因子1、25羟维生素D3 水平变化及其与糖脂代谢、胰岛素抵抗的相关性 J 安徽医药，2021，25(4):769772.17徐妍，李林霞.血清摄食抑制因子 1、肥胖抑制素和胰高血糖素样肽 1 水平对妊娠期糖尿病不良妊娠结局的预测价值 J 第二军医大学学报，2021，42(12):14281433.18徐跃心，吕文豪，南洋，等.血清 PLAP 与妊娠期糖尿病的相关性 J 现代妇产科进展，2021，30(5):368370.修回日期:2022-10-28本文编辑:王雨妇女保健/论著子痫前期患者血栓弹力图变化特点及与母婴并发症发生的关系分析任丽萍，季丹，蔡蓓珺，陈维娜，唐龙英上海市长宁区妇幼保健院产科，上海 200050基金项目:上海市医学重点专科(zk2019B02)通信作者:唐龙英，Email:tlying0523 摘要:目的探讨子痫前期患者血栓弹力图(TEG)变化特点与母婴并发症发生的关系。方法选取 2021 年 1 月2021 年12 月于上海市长宁区妇幼保健院住院分娩符合入组标准的产妇 85 例，其中轻度子痫前期组 50 例，重度子痫前期组35 例，并取同期正常妊娠晚期产妇 85 例作为对照组。入院后 24 h 内抽肘中静脉血检测 TEG 参数，包括凝血反应时间()、凝固速率(K)、凝固角()、最大振幅(MA)及凝血综合指数(CI)，观察子痫前期患者血栓弹力图变化特点。监测子痫前期患者母婴并发症发生情况，并分析 TEG 与母婴并发症(产后出血、低蛋白血症、低于胎龄儿、胎盘血管病变)发生情况的相关性。结果子痫前期患者的、K 值较对照组产妇、K 值缩短，并随着子痫前期病情的发展进一步缩短(P0.05);子痫前期患者的、CI 值较对照组增大，并随着子痫前期病情的发展进一步增大(P0.05);MA 在 3 组间差异无统计学意义(P0.05)。有并发症组 TEG 参数中、K 低于无并发症组，CI、高于无并发症组(P0.05);而 TEG 的 MA 在两组中的差异无统计学意义(P0.05)。Spearman 相关分析表明，与产后出血发生情况呈负相关(r=0.305，P0.05)，与低蛋白血症发生情况呈负相关(r=0.317，P0.05)，与胎儿低于胎龄儿发生情况呈负相关(r=0.345，P0.05)，与胎盘血管病变发生情况呈负相关(r=0.264，P0.05);K 与产后出血发生情况呈负相关(r=0.236，P0.05)，K 与低蛋白血症发生情况无明显相关，K 与胎儿低于胎龄儿发生情况呈负相关(r=0.201，P0.05)，K 与胎盘血管病变发生情况无明显相关性;与产后出血发生情况呈正相关(r=0.267，P0.05)，与低蛋白血症发生情况无明显相关，与胎儿低于胎龄儿发生情况呈正相关(r=0.253，P0.05)，与胎盘血管病变发生情况呈正相关(r=0.165，P0.05);MA 与并发症发生情况无明显相关性;CI 与产后出血发生情况呈正相关(r=0.395，P0.05)，CI 与低蛋白血症发生情况呈正相关(r=0.395，P0.05)，CI 与胎儿低于胎龄儿发生情况呈正相关(r=0.416，P0.05)，CI 与胎盘血管病变发生情况呈正相关(r=0.372，P0.05)。结论TEG 参数中 K、CI 参数的变化与子痫前期产妇的病情严重程度有关，也与产后出血、低蛋白血症、低于胎龄儿及胎盘血管病变的发生情况有一定的相关性，其中 和 CI 对各并发症均有显著相关性，值得在临床上推广 TEG 的有关应用。关键词:子痫前期;血栓弹力图;参数;母婴;并发症中国图书分类号:714.7文献标识码:A文章编号:1001-4411(2023)03-0393-04;doi:10.19829/j.zgfybj.issn.10014411.2023.03.002The relationship between thromboelastography and maternalfetalcomplications in preeclampsiaEN Liping，Ji Dan，CAI Beijun，CHEN Weina，TANG LongyingDepartment of Obstetrics，Changning District Maternity Hospital，Shanghai，200050，ChinaAbstract:ObjectiveTo investigate the relationship between the characteristics of thrombus elastogram(TEG)and maternal compli-cations in preeclampsia.MethodsA total of 85 parturients who delivered in Changning District Maternity hospital，Shanghai，from January2021 to December 2021 and met the inclusion criteria were selected，including 50 cases in mild preeclampsia group and 35 cases in severepreeclampsia group，and 85 cases in normal third trimester parturients during the same period were selected as the control group.TEG pa-rameters，including coagulation reaction time()，coagulation rate(K)，coagulation Angle()，maximum amplitude(MA)，and coagu-lation composite index(CI)，were measured by venous blood extraction from elbow within 24h after admission to observe the characteristicsof thromboelastogram changes in preeclampsia patients.The incidence of maternal and infant complications in patients with preeclampsia wasmonitored，and the correlation between thromboelasmogram and maternaland infant complications(including postpartum hemorrhage，hypopro-teinemia，low fetal age，and placental vasculopathy)was analyzed.393中国妇幼保健2023 年 2 月第 38 卷第 3 期Maternal and Child Health Care of China.February 2023，Vol.38，No.3esultsThe and K values of preeclampsia patients were shorter than those of control group，and further decreased with the developmentof preeclampsia(P0.05).The and CI values of preeclampsia patients were higher than those of control group，and further increasedwith the development of preeclampsia(P0.05).There was no significant difference in MA among the three groups(P0.05).TEG pa-rameters and K in complication group were lower than those in complication group，CI and were higher than those in complication group(P0.05).There was no significant difference in TEG MA between the two groups(P0.05).Spearman correlation analysis showed that was negatively correlated with the occurrence of postpartum hemorrhage(r=0.305，P0.05)，was negatively correlated with the oc-currence of hypoproteinemia(r=0.317，P0.05)，was negatively correlated with the occurrence of infants below gestational age(r=0.345，P0.05).was negatively correlated with the incidence of placental vascular lesions(r=0.264，P0.05).K was negativelycorrelated with the occurrence of postpartum hemorrhage(r=0.236，P0.05)，and had no significant correlation with the occurrence ofhypoproteinemia.K was negatively correlated with the occurrence of infants below gestational age(r=0.201，P0.05)，and had no signif-icant correlation with the occurrence of placental vascular lesions.There was a positive correlation between and postpartum hemorrhage(r=0.267，P0.05)，and hypoproteinemia(r=0.253，P0.05)，and placental vascular lesions(r=0.165，P0.05).MA had nosignificant correlation with the incidence of complications.CI was positively correlated with the occurrence of postpartum hemorrhage(r=0.395，P0.05)，CI was positively co