D-二聚体水平联合血栓弹力图评估妊娠期高血压患者凝血功能障碍的研究

doi:10.3760/cma.j.issn.1007-1245.2022.17.020

摘要/Abstract

摘要： 目的　探究D-二聚体（D-dimer，D-D）水平联合血栓弹力图（thromboelastography，TEG）评估妊娠期高血压患者凝血功能障碍的应用价值。方法　选取2020年1月至2021年1月临沂经济技术开发区人民医院接诊的100例妊娠期高血压患者作为观察组研究对象，按照是否合并凝血功能障碍分为A组（妊娠期高血压组）68例、B组（妊娠期高血压凝血功能障碍组）32例；另外同期选取54例非妊娠期高血压且不合并凝血功能的健康产妇作为对照组研究对象。其中A组年龄（26.49±2.18）岁，B组年龄（26.83±2.34）岁，对照组年龄（26.71±2.29）岁。组间采用独立t检验，组内采用配对t检验。观察两组研究对象D-D水平、凝血功能指标以及TEG参数，并分析其与妊娠期高血压患者凝血功能障碍的关系。结果　B组D-D水平为（1.09±0.22）mg/L，高于A组（0.85±0.10）mg/L，且A、B两组均高于对照组（0.42±0.07）mg/L，差异均有统计学意义（均P<0.05）。B组TEG参数K［（1.28±0.12）min］、R［（4.08±0.39）min］均低于A组［K（1.56±0.17）min、R（4.23±0.44）min］，TEG参数CI（2.51±0.26）、MA［（69.15±7.02）mm］、Angle角［（69.73±7.02）°］、LY30［（1.07±0.24）%］均高于A组［CI（2.23±0.24）、MA（67.05±6.23）mm、Angle（68.39±6.85）°、LY30（0.98±0.11）%］，且A、B两组TEG参数K、R低于对照组［K（1.93±0.21）min、R（4.59±0.46）min］，TEG参数CI、MA、Angle角、LY30高于对照组［CI（1.47±0.13）、MA（64.97±6.52）mm、Angle（64.93±6.52）°、LY30（0.90±0.20）%］，差异均有统计学意义（F=24.015、7.875、37.050、4.190、4.181、2.020，均P<0.05）。B组凝血功能指标PT［（10.64±1.08）s］、APTT［（26.85±2.74）s］、FIB［（3.91±0.38）g/L］均低于A组［PT（11.35±1.16）s、APTT（24.53±2.84）s、FIB（4.02±0.43）g/L］，凝血功能指标TT［（16.28±1.64）s］高于A组［TT（15.43±1.56）s］，且A、B两组PT、APTT、FIB低于对照组［PT（11.87±1.22）s、APTT（29.06±2.94）s、FIB（4.32±0.44）g/L］，TT高于对照组［TT（14.98±1.51）s］，差异均有统计学意义（F=7.067、3.853、6.582、6.663，均P<0.05）。与D-D、TEG单项相比，二者联合对妊娠期高血压凝血功能障碍的诊断价值较高，差异有统计学意义（P<0.05）。结论　D-D在妊娠期高血压凝血功能障碍中呈高表达，TEG参数在妊娠期高血压中表达异常，提示上述指标可能参与妊娠期高血压凝血功能障碍的发生、发展过程中，二者联合检测对妊娠期高血压凝血功能障碍的诊断价值较高。

关键词: D-二聚体, 血栓弹力图, 妊娠期高血压, 凝血功能

Abstract: Objective　To explore the application value of D-dimer (D-D) level combined with thromboelastography in the evaluation of coagulation dysfunction in patients with gestational hypertension. Methods　A total of 100 patients with gestational hypertension who were admitted to People's Hospital of Economy and Technology Development Zone, Linyi from January 2020 to January 2021 were selected as the research objects of the observation group, and were divided into group A (68 cases; a pregnancy hypertension group) and group B (32 cases; a pregnancy hypertension coagulation dysfunction group) according to whether they were complicated with coagulation dysfunction or not. And 54 healthy puerperae without gestational hypertension and coagulation function were selected as the research objects of the control group (group N). Group A was (26.49±2.18) years old, group B (26.83±2.34), and group N (26.71±2.29). Independent-sample t test was used for the comparison between groups, and paired t test within group. The D-D levels, coagulation function indicators, and TEG parameters of the groups were observed, and their relationship with coagulation dysfunction in the patients with gestational hypertension was analyzed. Results　The D-D level in group B was higher than that in group A [(1.09±0.22) mg/L vs. (0.85±0.10) mg/L], and the levels in both groups were higher than that in the control group [(0.42±0.07) mg/L], with statistical differences (all P<0.05). The TEG parameters K, R, CI, MA, Angle angle, and LY30 were (1.28±0.12) min, (4.08±0.39) min, (2.51±0.26), (69.15±7.02) mm, (69.73±7.02)°, and (1.07±0.24)% in group B, were (1.56±0.17) min, (4.23±0.44) min, (2.23±0.24), (67.05±6.23) mm, (68.39±6.85)°, and (0.98±0.11)% in group A, and were (1.93±0.21) min, (4.59±0.46)min [CI (1.47±0.13), (64.97±6.52) mm, (64.93±6.52)°, and (0.90±0.20)% in the control group, with statistical differences (F=24.015，7.875、37.050，4.190，4.181 and 2.020； all P<0.05). The coagulation function indicators PT, APTT, FIB, and TT were (10.64±1.08) s, (26.85±2.74) s, (3.91±0.38)g/L, and (16.28±1.64) s in group B, were (11.35±1.16)s, (24.53±2.84) s, (4.02±0.43) g/L, and (15.43±1.56) g/L in group A, and were (11.87±1.22) s, (14.98±1.51) s, (29.06±2.94) s, and (4.32±0.44) s in the control group, with statistical differences (F=7.067，3.853，6.582 and 6.663； all P<0.05). Compared with D-D and TEG alone, the combination of the two had a higher diagnostic value for coagulation disorders in the patients with gestational hypertension, with a statistical difference (P<0.05). Conclusions　D-D is highly expressed and TEG parameters are abnormal in patients with gestational hypertension and coagulation dysfunction, suggesting that the above indicators may participate in the occurrence and development of coagulation dysfunction in patients with gestational hypertension. The joint test of the two has a high diagnostic value for coagulation dysfunction in patients with gestational hypertension.

Key words: D-dimer, Thromboelastography, Gestational hypertension, Coagulation function

于振英邱彩香. D-二聚体水平联合血栓弹力图评估妊娠期高血压患者凝血功能障碍的研究[J]. 国际医药卫生导报, 2022, 28(17): 2461-2465.

Yu Zhenying, Qiu Caixiang. D-dimer level combined with thromboelastography in evaluation of coagulation dysfunction in patients with gestational hypertension[J]. International Medicine and Health Guidance News, 2022, 28(17): 2461-2465.

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