妊娠期高血压疾病患者血栓弹力图参数与经典凝血功能指标的关联性及对患者下肢深静脉血栓发生的预测价值

目的探讨妊娠期高血压疾病(hypertensive disorder complicating pregnancy,HDCP)患者血栓弹力图(thromboelastogram,TEG)参数与经典凝血功能指标的关联性及对患者下肢深静脉血栓(deep vein thrombosis,DVT)发生的预测价值。方法选取2020年4~8月荆门市第二人民医院100例HDCP患者为研究对象,其中DVT组31例,非下肢深静脉血栓患者(N-DVT)组69例。比较两组一般资料、经典凝血功能指标血浆凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,FIB)、国际标准化比值(international normalized ratio,INR)、D-二聚体(D-Dimer,D-D)、血小板计数(platelet count,PLT)、血小板体积分布宽度(platelet distribution width,PDW)、血小板平均容积(mean platelet volume,MPV)]、TEG参数凝血反应时间(reaction time,R)、血凝块形成时间(clot formation time,K)、最大振幅(maximal amplitude,MA)、α角(α-Angle)],分析经典凝血功能指标、TEG参数与HDCP患者发生DVT的关联性及经典凝血功能指标、TEG参数的相关性,采用受试者工作特征(ROC)曲线评价TEG、经典凝血功能指标对DVT的预测价值。结果两组在年龄、PLT、PDW、MPV、PT、APTT、TT、FIB、D-D方面比较,差异均有统计学意义(P<0.05);DVT组TEG参数R、K低于N-DVT组,MA、α-Angle高于N-DVT组,差异有统计学意义(P<0.05);年龄、PLT、PDW、MPV、PT、APTT、TT、FIB、D-D、R、K、MA、α-Angle水平均为HDCP患者DVT发生的影响因素(P<0.05);偏相关性分析,将年龄等其他因素控制后,PLT、PDW、MPV、IPT、APTT、TT、FIB、D-D、R、K、MA、α-Angle仍与HDCP患者DVT发生显著相关(P<0.05);TEG参数R、K、MA、α-Angle与PLT、PDW、MPV、PT、APTT、TT、FIB、D-D相关(P<0.05);TEG参数、经典凝血功能指标联合预测HDCP患者DVT的曲线下面积(AUC)为0.931,高于各指标单一预测。结论HDCP患者TEG参数与经典凝血功能指标存在一定相关性,各指标联合检测可有效预测DVT发生,为临床开展针对性防治措施提供依据。

Correlation between the parameters of thromboelastogram and classic coagulation function indexes in HDCP patients and their predictive value for the occurrence of DVT

Objective To investigate the correlation between the thromboelastogram(TEG)parameters and classic coagulation function indexes in patients with hypertensive disorder complicating pregnancy(HDCP)and their predictive value of deep vein thrombosis(DVT)in the lower extremities.Methods From April to August 2020,100 patients with HDCP in Jingmen Second People's Hospital were selected as research subjects,including 31 cases in the DVT group and 69 cases in the N-DVT(non-deep vein thrombosis)group.The general information and classic coagulation function indexesprothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),fibrinogen(FIB),international normalized ratio(INR),D-dimer(DD),platelet count(PLT),platelet distribution width(PDW),mean platelet volume(MPV)]and TEG parameterscoagulation reaction time(R),clot formationtime(K),maximum amplitude(MA),α-Angle]of the two groups were compared.The correlation between classic coagulation function indexes,TEG parameters and the occurrence of DVT in HDCP patients,and the correlation between classic coagulation function indexes and TEG parameters were analyzed.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of TEG and classical coagulation function indexes for DVT.Results There were statistically significant differences between the two groups in terms of age,PLT,PDW,MPV,PT,APTT,TT,FIB,and D-D(P<0.05);the TEG parameters R and K of the DVT group were lower than those of the N-DVT group,and MA andα-Angle were higher than those of the N-DVT group,the differences were statistically significant(P<0.05);age,PLT,PDW,MPV,PT,APTT,TT,FIB,D-D,R,K,MA,α-Angle levels were all influencing factors for the occurrence of DVT in HDCP patients(P<0.05);after controlling for other factors such as age,through partial correlation analysis,the PLT,PDW,MPV,IPT,APTT,TT,FIB,DD,R,K,MA,α-Angle were still significantly related to the occurrence of DVT in HDCP patients(P<0.05);TEG parameters R,K,MA,α-Angle were related to PLT,PDW,MPV,PT,APTT,TT,FIB,D-D(P<0.05);the area under the curve(AUC)of the combination of TEG parameters and classical coagulation function indexes to predict DVT in HDCP patients was 0.931,which was higher than the single prediction of each index.Conclusion There is a certain correlation between TEG parameters of HDCP patients and classical coagulation function indexes.The combined detection of each index can effectively predict the occurrence of DVT and provide a basis for clinically targeted prevention and treatment measures.