凝血、甘油三酯水平预测早发型重度子痫前期孕妇分娩结局的分析

目的 观察凝血、甘油三酯(triglyceride, TG)在早发型重度子痫前期(early onset severe pre-eclampsia, EOSP)孕妇中的表达水平,并分析凝血、TG水平预测EOSP孕妇分娩结局的价值。方法 回顾性分析2019年1月至2020年12月于邯郸市中心医院产检并完成分娩的55例EOSP不良分娩结局孕妇的临床资料,设为不良组;另收集同期于本院产检并完成分娩的55例EOSP分娩结局良好孕妇的临床资料,设为良好组;收集孕妇病历资料,记录基线资料、凝血四项凝血酶原时间(prothrombin time PT)、凝血酶时间(thrombin time, TT)、纤维蛋白原(fibrinogen, FIB)、活化部分凝血活酶时间(activatedpartial thromboplastin time, APTT)]及TG水平,并分析凝血、TG水平预测EOSP孕妇不良分娩结局风险的价值。结果 两组年龄、分娩时孕周、产妇类型、体质量指数、TT水平比较,差异无统计学意义(P>0.05);不良组孕妇PT、APTT、高密度脂蛋白胆固醇(high density lipoprotein cholesterol, HDL-C)水平均低于良好组,FIB、TG、总胆固醇(total cholesterol, TC)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol, LDL-C)水平均高于良好组(P<0.05);相关性检验发现,EOSP孕妇分娩结局与PT、APTT、HDL-C水平呈负相关(r<0,P<0.05),与FIB、TG、TC、LDL-C水平呈正相关(r>0,P<0.05),与TT水平无相关性(P>0.05);绘制ROC曲线,血清PT、APTT低表达、TG、FIB过表达预测EOSP孕妇不良分娩结局风险的曲线下面积(AUC)>0.80,有一定预测价值,且当四者cut-off值分别取10.13 s、23.47 s、2.64 mmol/L、4.54 g/L时,可获得最佳预测价值。结论 凝血、TG与EOSP孕妇分娩结局有关,PT、APTT低表达、TG、FIB过表达预测EOSP孕妇不良分娩结局风险有一定价值,可考虑早期监测EOSP孕妇凝血、TG指标,指导不良分娩结局风险预测。

Analysis of blood coagulation and triglyceride levels in predicting delivery outcome of pregnant women with early onset severe pre-eclampsia

Objective To observe the expression of blood coagulation and triglyceride(TG) in pregnant women with early onset severe pre-eclampsia(EOSP),and to analyze the value of blood coagulation and TG levels in predicting the delivery outcome of pregnant women with EOSP.Methods The clinical data of 55 EOSP pregnant women with adverse delivery outcomes who underwent prenatal examination and completed delivery in Handan Central Hospital from January 2019 to December 2020 were retrospectively analyzed, and set as the adverse group;in addition, the clinical data of 55 EOSP pregnant women with good delivery outcomes who underwent prenatal examination and completed delivery in our hospital during the same period were collected, and set as the good group;the medical records of pregnant women were collected, the baseline data, four coagulation items prothrombin time(PT),thrombin time(TT),fibrinogen(FIB),activated partial thromboplastin time(APTT)] and TG levels were recorded, and the value of coagulation and TG levels in predicting the risk of adverse delivery outcomes of pregnant women with EOSP was analyzed.Results There were no significant differences in age, gestational age at delivery, maternal type, body mass index and TT level between the two groups(P>0.05);the levels of PT,APTT and high density lipoprotein cholesterol(HDL-C) in the adverse group were lower than those in the good group, and the levels of FIB,TG,total cholesterol(TC) and low density lipoprotein cholesterol(LDL-C) in the adverse group were higher than those in the good group(P<0.05);Correlation test showed that the delivery outcome of pregnant women with EOSP was negatively correlated with PT,APTT and HDL-C levels(r<0,P<0.05),it was positively correlated with FIB,TG,TC and LDL-C(r>0,P<0.05),there was no correlation with TT level(P>0.05);the ROC curve was drawn, the AUC of low expression of serum PT and APTT,over expression of serum TG and FIB in predicting the risk of adverse delivery outcomes of pregnant women with EOSP were >0.80,which had certain predictive value, when the cut-off values of the four factors were 10.13 s, 23.47 s and 2.64 mmol/L,4.54 g/L respectively, the best predictive value could be obtained.Conclusion Coagulation and TG are related to the delivery outcome of pregnant women with EOSP,the low expression of PT and APTT,the over expression of TG and FIB have certain value in predicting the risk of adverse delivery outcome of pregnant women with EOSP,early monitoring of coagulation and TG indexes of pregnant women with EOSP can be considered, which can guide the prediction of risk of adverse delivery outcomes.