早发型和晚发型重度子痫前期临床指标的对比研究

目的对比早发型和晚发型重度子痫前期孕妇凝血纤溶指标、血浆同型半胱氨酸(plasma homocysteine,t-Hcy)、血脂、甲状腺功能、24 h尿蛋白特征,并探讨上述指标与围产儿结局的关系。方法纳入2013年1月至2016年1月深圳市妇幼保健院产科住院分娩的重度子痫前期患者180例为研究对象,将其按发病时间分为早发型组(发病时间34孕周,109例)及晚发型组(发病时间≥34孕周,71例),选取同期80例正常孕妇为对照组。检测并对比3组孕妇凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、血小板计数(blood platelet count,PLT)、纤维蛋白原(fibrinogen,Fg)、D-二聚体(D-Dimer,DD)、组织纤溶酶原激活物(tissue-type plasminogen activator,t-PA)、组织纤溶酶原激活物抑制剂(tissue-type plasminogen activator inhibitor,PAI-I)、血浆t-Hcy、总胆固醇(total cholesterol,TC)、三酰甘油(triacylglycerol,TG)、低密度脂蛋白(low density lipoprotein,LDL)、高密度脂蛋白(high density lipoprotein,HDL)、载脂蛋白A(apolipoprotein A,apoA)、载脂蛋白B(apolipoprotein B,apoB)、促甲状腺激素(thyrotropic hormone,TSH)、游离三碘甲状腺原氨酸(free triiodothyronine,FT_3)、游离甲状腺素(free thyroxine,FT_4)、24 h尿蛋白定量水平及围产儿结局。纳入上述指标,进行回归分析,明确围产儿不良妊娠结局的影响因素。结果 (1)早发型组PT、APTT、PLT、HDL、apoA、TSH低于晚发型组,Fg、DD、t-PA、PAI-I、tHcy、TC、TG、LDL、apo B、24 h尿蛋白定量高于晚发型组,差异均有统计学意义(P0.05)。(2)早发型组新生儿体重轻于晚发型组,围生儿死亡及新生儿窒息率高于晚发型组,差异均有统计学意义(P0.05)。结论早发型重度子痫前期患者血液高凝状态、高脂血症及高t-Hcy血症更严重,上述症状可能直接导致早发型重度子痫前期患者围产儿结局差于晚发型重度子痫前期患者。

A comparative study of clinical indexes of early-onset and late-onset severe preeclampsia

Objective To compare coagulation and fibrinolysis solution index, plasma homocysteine(t-Hcy),blood lipids,thyroid function and 24h urine protein characteristics in early-onset and late-onset severe preeclampsia, and to explore the correction between above indexes and perinatal outcomes.Methods From January 2013 to January 2016, 180 cases of severe preeclampsia patients who were hospitalized in Shenzhen Maternal and Child Health Hospital were divided into early-onset group (onset time <34 weeks of gestation, 109 cases) and late-onset group (onset time≥34 weeks of gestation, 71 cases).80 cases of normal pregnant women were selected as the control group.Prothrombin time (PT),activated partial thromboplastin time(APTT),platelet count(PLT),fibrinogen(Fg),two D-dimer(DD) tissue plasminogen activator (t-PA),plasminogen activator inhibitor(PAI-I),plasma t-Hcy,total cholesterol(TC), triacylglycerol (TG),low density lipoprotein protein(LDL),high density lipoprotein(HDL),apolipoprotein A(apoA),apolipoprotein B(apoB),thyroid stimulating hormone (TSH), free triiodothyronine (FT3),free thyroxine(FT4),24 h urinary protein level and perinatal outcomes of the three groups were detected and compared.Regression analysis including the above indicators was used to determine the influencing factors of adverse pregnancy outcomes in perinatal children.Results ① Compared with the late-onset group, Pt, APTT, PLT,HDL,apoA and TSH in the early-onset group were significantly lower, Fg,DD,t-PA,PAI-I,t-Hcy,TC,TG,LDL,apoB and 24h urinary protein quantitative were significantly higher, the differences were statistically significant (P<0.05).② Neonatal weight in early-onset group was significantly lighter than the late-onset group(P<0.05),the perinatal mortality and neonatal asphyxia rate of early-onset group were better than those of late-onset group(P<0.05).Conclusion Hypercoagulable state of blood, hyperlipidemia and high t-Hcy hyperlipidemia are more serious in early-onset severe preeclampsia patients.These symptoms may directly lead to the result that early-onset severe preeclampsia patients with perinatal outcomes worse than late-onset severe preeclampsia patients.