早孕期稽留流产患者凝血功能变化及危险因素分析

目的探讨早孕期稽留流产患者高危因素及凝血功能变化情况。方法回顾性选取2018年3月~2018年9月安徽医科大学附属妇幼保健院治疗的早孕期稽留流产患者349例作为观察组,同时期行人工流产的153例早孕期患者作为对照组。分析两组患者的一般资料、血常规和凝血指标,采用Logistic回归分析评估早孕期稽留流产的高危因素。结果观察组年龄大于对照组(P<0.001),自然流产次数多于对照组(P<0.05)。与对照组相比,观察组D-二聚体浓度增高;凝血酶原时间、活化部分凝血活酶时间及凝血酶时间延长,纤维蛋白降解产物及纤维蛋白原浓度降低;在观察组中复发组D-二聚体浓度高于初发组;两组血小板计数差异无统计学意义(P>0.05)。Logistic回归分析显示年龄、自然流产史是早孕期发生稽留流产的单独危险因素。结论早孕期稽留流产患者体内呈现轻度纤溶亢进状态,但多数患者凝血指标无明显异常;年龄和自然流产史是早孕期发生稽留流产的高危因素。对年龄>25岁或有自然流产史的早期妊娠妇女进行凝血功能检测有助于临床采取合适的干预措施,降低稽留流产的发生率。

Changes of Coagulation Function and Risk Factors in Early Pregnancy Patients with Missed Abortion

Objective To investigate risk factors and the changes of coagulation function in early pregnancy patients with missed abortion.Methods The retrospective study was performed.A total of 349 patients diagnosed with missed abortion in early pregnancy in Maternal and Child Health Hospital Affiliated to Anhui Medical University between March 2018 and September 2018 were selected as observation group.153 normal pregnancy women who had artificial abortion due to unplanned pregnancy at the same period were selected as control group.The characteristics of general information,blood routine and coagulation tests of the two groups were analyzed.Logistic regression analysis was used to identify risk factors.Results①Age in observation group was older than that in control group(29.68±4.72 vs 27.64±5.38,P<0.001).The number of spontaneous abortions was also higher than that in control group(0.19±0.53 vs 0.06±0.29,P=0.001).②The level of D-dimer was higher,and fibrinogen degradation product(FDP)and fibrinogen were lower in observation group compared to those in control group.In observation group,D-dimer level in recurrence group was higher than that in newly diagnosed group.Prothrombin time(PT),activated partial thromboplastin time(APTT)and thrombin time(TT)in observation group were higher than that in control group(P<0.01).There was no significant difference in platelet count between the two groups(P>0.05).③Logistic regression analysis showed that age and history of spontaneous abortion were risk factors for missed abortion:Age≥25~30 years old(odds ratio(OR)5.690;95%CI 3.184~10.168),age≥30 years(OR 9.882;95%CI 4.949~19.731),history of spontaneous abortion(OR4.994;95%CI 1.881~13.257).Conclusion Although patients with missed abortion during early pregnancy showed hyperfibrinolysis,most patients had no obvious coagulation abnormality.Age and a history of spontaneous abortion were the risk factors for missed abortion.For women aged older than 25 years or with a history of spontaneous abortion in early pregnancy,coagulation tests might help reduce their incidence of missed abortion by appropriate interventions.