徐海霞　　伊碧霞　　徐攀　　项美姣

[關键词] 血栓弹力图;常规凝血功能检测;复发性流产;凝血功能;血小板计数;凝血酶时间;凝血形成速率;凝血指数

[中图分类号] R687.3          [文献标识码] B          [文章编号] 1673-9701（2021）16-0079-04

Application effect of thromboelastogram and routine coagulation function test in coagulation function of early recurrent miscarriage patients

XU Haixia   YI Bixia   XU Pan   XIANG Meijiao

1.Department of Obstetrics and Gynecology， Jinhua City People′s Hospital， Jinhua   321000， China; 2.Intensive Care Unit， Jinhua City People′s Hospital， Jinhua   321000 China

[Abstract] Objective To explore the effect of thromboelastography and routine coagulation function test in coagulation function of patients with early recurrent miscarriage. Methods From February 2018 to March 2019， 80 patients with recurrent miscarriage admitted to the Department of Obstetrics and Gynecology of Jinhua People′s Hospital were selected as the observation group， and 80 pregnant women with normal childbearing during the same period were selected as the control group. Both groups of patients underwent routine coagulation function test and thromboelastography test. The test results of the two groups of patients were compared. Results The activated partial thromboplastin time （APTT） in the routine coagulation function test values of the observation group was lower than that of the control group， and the fibrinogen （FIB） and D-dimer （DD） of the observation group were higher than those of the control group （t=2.403， 7.050， 1.024， 0.308， 0.168， P=0.017， 0.000， 0.307， 0.758， 0.867）. There was no statistical difference in prothrombin time （PT）， thrombin time （TT） and platelet count （PLT） between the two groups （P>0.05）. The coagulation reaction time （R value） and clot formation time （K value） in the thromboelastogram test values of the observation group were lower than those of the control group， and the coagulation rate （Angle angle）， the maximum amplitude （MA value） and the coagulation index （CI value） of the observation group were significantly higher than those of the control group（t=11.408， 7.553， 15.925， 4.059， 15.292， P=0.000）. In the observation group， R value was positively correlated with APTT and negatively correlated with DD， K value was negatively correlated with FIB and PLT， Angle angle， MA value， and CI value were all positively correlated with FIB and PLT（P<0.05）. Conclusion Patients with early recurrent miscarriage are in a hypercoagulable state. Thromboelastography and routine coagulation function tests are correlated with platelet counts. Monitoring thrombus elastography can help guide patients with early recurrent miscarriage to receive antiplatelet therapy.

[Key words] Thromboelastography; Routine coagulation function test; Recurrent miscarriage; Coagulation function; Platelet count; Thrombin time; Coagulation rate; Coagulation index

复发性流产（recurrent spontaneous abortion，RSA）是指连续发生2次或2次以上的自然性流产[1]。RSA病因十分复杂，不同妊娠期产妇病因有所区别，妊娠12周以前的早期流产多由遗传因素、内分泌异常、生殖免疫功能紊乱等因素所致;妊娠12至28周的晚期流产一般为血栓前状态及感染所致[2-4]。部分患者可能同时存在多种致病因素，所以针对RSA患者病因复杂多样且缺乏特异性的表现，在病因诊断及治疗过程需对患者凝血功能进行及时监测。目前对于凝血功能常规检测方法整体性检测效果较低，且易受凝血剂的影响，近年来随着医学研究不断改进，血栓弹力图在临床中被广泛应用，对凝血和纤溶的整个过程实施动态监测可明确凝血功能发生异常的原因，在心外科手术、肝脏移植及创伤等领域得到应用广泛[5-6]。所以本研究对早期复发性流产患者进行常规凝血功能检测及血栓弹力图，对比分析两种方法对早期复发性流产患者的检测效果，现报道如下。

1 资料与方法

1.1 一般资料

选取2018年2月至2019年3月金华市人民医院妇产科收治的早期复发性流产患者80例作为观察组，观察组患者中，年龄22～35岁，平均（29.5±3.3）岁;流产次数2～4次，平均（2.1±0.6）次;孕周9～11周，平均（10.2±1.1）周。患者均符合复发性流产的诊断标准[7]。另选取同期正常生育期孕妇80例作为对照……