周夏青　刘雪琴　赵琳

[关键词] 妊娠期高血压疾病;凝血功能;血小板;血栓前状态

[中图分类号] R714.246          [文献标识码] B          [文章编号] 1673-9701（2021）23-0056-04

Clinical significance of coagulation function indices on the diagnosis of prethrombotic state in gestational hypertension

ZHOU Xiaqing1， 2   LIU Xueqin2   ZHAO Lin2

1.Postgraduate Cultivation Base of Jinzhou Medical University， Taihe Hospital of Shiyan City in Hubei Province， Shiyan 442000， China; 2.Department of Obstetrics and Gynecology， Taihe Hospital of Shiyan City in Hubei Province， Shiyan 442000， China

[Abstract] Objective To probe into the clinical significance of coagulation function， platelets and other related indices on the diagnosis of prethrombotic state in gestational hypertension. Methods A total of 179 cases of pregnant women with gestational hypertension who were hospitalized in the Department of Obstetrics in Taihe Hospital of Shiyan City from June 2010 to June 2020 were selected. They were divided into the mild preeclampsia group （group B， n=79） and the severe preeclampsia group （group C， n=100）， and another 243 cases of pregnant women with normal late gestation were selected and included in group A. A total of eight indices， including prothrombin time， activated partial thromboplastin time， thrombin time， fibrinogen degradation products， fibrinogen， platelet count， mean platelet volume and D-dimer， were compared among the three groups. Results The levels of PT， TT shortened gradually， and PLT decreased gradually among Group A， Group B and Group C， with statistically significant difference （P<0.05）. The levels of FIB， MPV， DD， FDP rised gradually among Group A， Group B and Group C， with statistically significant difference（P<0.05）. The levels of APTT extended gradually among Group A， Group B and Group C， but without statistically significant difference（P>0.05）. Conclusion Changes in coagulation and platelet indices have clinically important significance for the diagnosis and prevention of prethrombotic state in gestational hypertension.

[Key words] Gestational hypertension; Coagulation function; Platelets; Prethrombotic state

妊娠期高血壓疾病（Hypertensive disorders of pregnancy，HDP）是妊娠期特有的疾病，是妊娠合并血压升高并存的一组疾病，妊娠期高血压疾病在妊娠中的发生率为5%～12%，是指妊娠20周后出现的血压升高、蛋白尿及水肿等一系列症状的综合征[1]。子痫前期产妇血液高凝、慢性弥漫性血管内凝血（Disseminated intravascular coagulation，DIC）、脂质过氧化、血管内皮损伤易形成血栓前状态（Prethrombotic state，PTS）[2]，临床表现为促凝血物质，如纤维蛋白原、血管性血友病因子等升高， 而抗凝血物质减少，从而激活凝血系统，血管内形成微血栓，导致子痫前期-子痫患者慢性DIC、各脏器的血流灌注减少， 而出现与子痫前期、子痫直接相关的临床表现。病理性PTS可导致胎盘循环微血栓形成，影响胎儿生长发育及母体健康。对妊娠高血压晚期孕妇与正常妊娠晚期孕妇凝血四项、血小板功能指标，以及血小板相关PTS分子标志物水平进行比较观察，探讨其临床意义，现报道如下。

1 对象与方法

1.1 研究对象

选择2010年6月至2020年6月十堰市太和医院住院治疗的妊娠高血压晚期患者179例，分为轻度子痫前期组（B组）79例和重度子痫前期组（C组）100例。轻度子痫前期组中位年龄31.2岁;孕龄32～39周，中位数36.6周。重度子痫前期组中位年龄31.8岁;孕龄26～40周，中位数32.9周。另外选择正常妊娠晚期（A组）243例，中位年龄30.3岁;孕龄37～41周，中位38.8周。纳入标准：轻、重度子痫前期诊断根据2020年妊娠期高血压疾病诊疗指南;排除标准：患有其他严重器质性病变及血液系统疾病者，近期未服用影响血小板功能的药物[3]者。……