网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
凝血三项、D-二聚体检测联合血栓弹力图判断孕妇凝血状态的临床价值
作者:李相怡1  郭红荔2 
单位:1. 琼海市妇幼保健院 检验科, 海南 琼海 571400;
2. 海南省人民医院 检验科, 海南 海口 570311
关键词:孕妇 凝血酶原时间 活化部分凝血活酶时间 纤维蛋白原 血栓弹力图 D-二聚体 妊娠结局 
分类号:R714
出版年·卷·期(页码):2019·47·第七期(783-786)
摘要:

目的:探讨临产孕妇血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)检测联合血栓弹力图(TEG)检测用于判断孕妇凝血状态的临床价值。方法:以在琼海市妇幼保健院接受临产检查的孕妇160例为观察组,另选择未妊娠健康女性80例为对照组,分析两组凝血三项(PT、APTT、FIB)、D-D及TEG检测的结果,以及凝血三项、D-D值与TEG检测值的关系。根据凝血三项、D-D及TEG参数是否异常,将观察组再分为异常组(凝血三项、D-D及TEG参数至少2项异常)和正常组,分析凝血三项、D-D及TEG参数与静脉血栓栓塞、弥散性血管内凝血(DIC)、胎膜早破、产后大出血、新生儿体质异常、产妇死亡、新生儿死亡等的关系。结果:观察组PT、APTT短于对照组(均P<0.05),TEG的凝血反应时间(R值)、血块形成时间(K值)低于对照组(均P<0.05);观察组FIB、D-D水平及TEG最大振幅(MA值)高于对照组(均P<0.05)。TEG的R、K值与PT、APTT水平呈正相关,与FIB、D-D水平呈负相关(均P<0.05);MA值与PT、APTT呈负相关,与FIB、D-D水平呈正相关(P<0.05)。传统常规凝血试验与TEG检测对评估高凝状态具有较好的一致性(Kappa值=0.812)。异常组静脉栓塞、DIC、胎膜早破、产后大出血、新生儿体质异常、产妇死亡、新生儿死亡等的总发生率高于正常组(P<0.05)。结论:凝血三项、D-D检测联合TEG有助于科学评估临产孕妇的凝血功能,预测临床孕妇的妊娠结局,为围产期大出血、DIC的预防及治疗提供参考依据。

Objective:To explore the clinical significance of plasma prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer (D-D) and thromboela-stogram (TEG) in judging the coagulation status for pregnant women. Methods:One hundred and sixty cases of pregnant women undergoing labor examination in Qionghai Maternal and Child Health Hospital were selected as observation group, another 80 healthy women without pregnancy were selected as control group. The results of three items of coagulation(PT,APTT,FIB), D-D test and TEG test of thetwo groups and the relationship between the three items of coagulation, D-D and TEG were analyzed. According to whether three items of coagulation, D-D and TEG parameters were normal or not, the pregnant women in the observation group were divided into abnormal group (at least two abnormalities were found in three items of coagulation, D-D and TEG parameters) and normal group, the relationship between three items of coagulation, D-D,TEG parameters and the incidence of venous thromboembolism, disseminated intravascular coagulation (DIC), premature rupture of membranes, postpartum hemorrhage, abnormal neonatal constitution, maternal death and neonatal death were analyzed. Results:PT and APTT in the observation group were shorter than those in the control group (all P<0.05), The coagulation reaction time (R value) and clot formation time (K value) of TEG in the observation group were lower than those in the control group (all P<0.05). The levels of FIB and D-D and the maximum amplitude (MA value)of TEG in the observation group were higher than those in the control group (all P<0.05). The R and K values of TEG were positively correlated with PT and APTT, but negatively correlated with FIB and D-D levels (all P<0.05). MA value of TEG was negatively correlated with PT and APTT, and positively correlated with FIB and D-D levels (P<0.05).Traditional routine coagulation test had good consistency with TEG test in evaluating hypercoagulability (Kappa value=0.812). The total incidence of vein embolism, DIC, premature rupture of membranes, postpartum hemorrhage, abnormal neonatal constitution, maternal death and neonatal death of theabnormal group were higher than those of the normal group (P<0.05). Conclusion:Combination of the three coagulation tests, D-D test and TEG test can help to scientifically evaluate the coagulation function of pregnant women, predict the pregnancy outcome of clinical pregnant women, and provide reference for the prevention and treatment of perinatal massive hemorrhage and DIC.

参考文献:

[1] 吴鹏,桂培根,黄菊芳,等.重组人源性凝血因子Ⅶa治疗产后出血13例疗效分析[J].中南医学科学杂志,2016,44(2):209-210,223.
[2] 唐万兵.临产孕妇监测D-二聚体对预防产后出血的临床价值[J].检验医学与临床,2016,13(z2):399-400.
[3] 崔俊林.冷沉淀凝血因子在产科弥散性血管内凝血的应用效果[J].国际检验医学杂志,2017,38(2):243-245.
[4] 王玉连,陈洪,刘洋,等.血栓弹力图在评估肝硬化患者凝血状态中的作用[J].东南大学学报(医学版),2016,35(2):215-219.
[5] PANDEY C K,SALUJA V,GAURAV K,et al. K time & maximum amplitude of thromboelastogram predict post central venous cannulation bleeding in patients with cirrhosis:a pilot study[J].Indian J Med Res,2017,145(1):84-89.
[6] 耿玮,张志刚,皮斌,等.血栓弹力图与传统凝血检查监测围关节置换期的凝血状态[J].中国组织工程研究,2015,19(48):7709-7716.
[7] 叶昱坪,王艳.乳腺癌患者血栓弹力图与常规凝血试验相关性分析[J].中国输血杂志,2017,30(4):368-371.
[8] 佘仕金,熊旭芳.凝血联合纤溶指标的检测在妊娠高血压综合征中的诊断价值[J].标记免疫分析与临床,2016,23(9):1010-1012.
[9] DELABRANCHE X,STIEL L,SEVERAC F,et al.Evidence of netosis in septic shock induced disseminated intravascular coagulation[J].Shock,2017,47(3):313-317.
[10] 陈峻峰,刘必成,杨江生,等.血栓弹力图评估微炎症状态下腹膜透析患者凝血功能变化的价值[J].东南大学学报(医学版),2015,34(3):361-364.
[11] 蔡毅,崔华,范利,等.血栓弹力图研究进展概况[J].中华老年心脑血管病杂志,2014,16(11):1217-1218.
[12] 杨军,刘晓辉,李玲,等.血栓弹力图评估血小板功能有助于缩短患者冠状动脉搭桥术前等待时间[J].中华检验医学杂志,2017,40(2):114-118.
[13] 任召祺,段光华,李俊祺,等.血栓弹力图测定结果的比对研究[J].现代生物医学进展,2015,15(17):3329-3332.
[14] 王桂卿,付锦华,毕淑娜,等.血栓弹力图预测早期复发性流产的研究[J].中国妇幼健康研究,2016,27(8):982-984.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 729204 位访问者


 ©《现代医学》编辑部
联系电话:025-83272481;83272479
电子邮件: xdyx@pub.seu.edu.cn

苏ICP备09058541