不同流产次数的复发性流产患者血栓弹力图比较研究

目的探究血栓弹力图(thrombelastograph,TEG)在不同流产次数的复发性流产(recurrent spontaneous abortion,RSA)患者凝血功能中的变化趋势,为早期不同流产次数RSA患者的诊断和治疗提供有效的检测指标。方法选取2018年1月至2019年1月湘潭市中心医院不孕不育科治疗的147例不同流产次数的RSA已孕患者为研究对象,设为观察组,根据不同孕周将其分为早孕组(平均妊娠6^+6周)35例,早中孕组(平均妊娠13^+6周)47例,中孕组(平均妊娠18^+6周)65例;并根据不同流产次数将流产≥4次者分为流产4组(31例),流产3次者分为流产3组(69例),流产2次者分为流产2组(47例)。从同时期于我院建立生产档案的健康孕妇中随机抽取160例为健康对照组。观察两组孕妇TEG检测5项参数变化情况,并对比不同RSA患者TEG变化情况。结果经TEG检测后,凝血指数(coagulation index,CI)均值都在3以上,观察组和对照组孕妇均呈血液高凝状态,观察组各项指标更偏向高凝状态,R值和K值缩短,α角和MA值增大,CI值升高,与对照组比较差异有统计学意义(P<0.05)。在不同孕周患者中,R、MA及CI值比较差异无统计学意义(P>0.05);K值随孕周的增加而降低,α值随孕周的增加而升高,3组比较差异有统计学意义(P<0.05);流产4组的MA值高于流产3组、流产2组(P<0.05);R、K、α角及CI值比较,差异无统计学意义(P>0.05)。结论在不同流产次数的RSA患者中应用TEG检测,可在早期准确反映出患者RSA的倾向,且患者既往流产次数越多(≥4次),TEG的参数MA增加得越明显,其主要表现为血小板聚集功能增强的凝血功能异常。

Comparative study of thromboelastograms in patients with recurrent spontaneous abortion with different abortion times

Objective To explore the trend of thromboelastography(TEG)in the coagulation function of patients with recurrent spontaneous abortion(RSA)with different abortion times,and provide effective detection indicators for the diagnosis and treatment of RSA patients with different abortion times.Methods A total of 147 RSA pregnant patients with different abortions who were treated by the Infertility Department of Xiangtan Central Hospital from January 2018 to January 2019 were selected as the observation group.According to different gestational weeks,they were divided into early pregnancy group(average pregnancy 6^+6 weeks)35 cases,early-middle pregnancy group(average pregnancy 13^+6 weeks)47 cases,middle pregnancy group(average pregnancy 18^+6 weeks)65 cases;and according to the different abortion times,those who had abortion≥4 times were divided into abortion 4 group(31 cases),who had 3 times abortion were divided into abortion 3 group(69 cases),and who had twice abortion were divided into abortion 2 group(47 cases).A total of 160 healthy pregnant women were randomly selected from healthy pregnant women who established production files in our hospital at the same time as corro group.The changes of 5 parameters of TEG test in two groups of pregnant women were observed,and the changes of TEG in RSA patients with different abortion times were compared.Results After TEG detection,the mean coagulation index,CI was above 3,and the pregnant group in the observation group and the control group showed hypercoagulability.The indicators in the observation group were more hypercoagulable,the R and K values were shortened,and the α and MA values were increased,the CI value increased,and the difference was statistically significant compared with the control group(P<0.05).There were no significant differences in R,MA and CI values between the different gestational age patients(P>0.05).The K value decreased with the increase of gestational age,and theαvalue increased with the increase of gestational age,the difference between the three groups was statistically significant(P<0.05);the MA value of abortion 4 group was higher than that of abortion 3 group and abortion 2 group(P<0.05),there was no significant difference in R,K,α and CI values(P>0.05).Conclusion The application of TEG in RSA patients with different abortion times can accurately reflect the tendency of RSA in patients at an early stage,and the more frequent abortions(≥4 times),the more obvious the parameter MA of TEG is increased,which is mainly characterized by abnormal blood coagulation function enhanced by platelet aggregation.