Objectives: The number of gestational women has been increased in recent years, resulting in more adverse pregnancy outcomes. It is crucial to assess the coagulation function of pregnant women and to intervene in a timely manner. This study aims to analyze the influencing factors on thrombelastography (TEG) and explore the evaluation of TEG for gestational women.
Methods: A retrospective study was conducted on 449 pregnant women who were hospitalized in the obstetrics department in Xiangya Hospital of Central South University from 2018 to 2020. We compared the changes on the TEG parameters among normal pregnant women between different age groups, different ingravidation groups, and different stages of pregnancy groups. The influence on TEG of hypertensive disorders in pregnancy (HDP) and gestational diabetes mellitus (GDM) as well as two diseases synchronization was explored.
Results: Compared with the normal second trimester women, the R values and K values of TEG were increased, and α angle, CI values and LY30 values were decreased in third trimester women (all P<0.05). Compared with normal group, the R values and CI values of TEG of the HDP group have significant difference (both P<0.05). There were no significant difference of TEG between the GDM group, the HDP combined with GDM group and the normal group (all P>0.05). Multiple linear regression analysis showed that the influencing factors for R value in TEG were weeks of gestation (P<0.001) and mode of conception (P<0.05), for α angle was weeks of gestation (P<0.05), for MA value was mode of conception (P<0.05), and for CI value was weeks of gestation (P<0.05). The analysis of correlation between TEG with platelet (PLT) and coagulation routines represented that there was a correlation between TEG R values and activated partial thromboplastin time (APTT) (P<0.01), and negative correlation between TEG CI values and APTT (P<0.05). There was a negative correlation between TEG K values and FIB (P<0.05). The correlation of α angle (P<0.05), MA values (P<0.01) and CI values (P<0.05) with FIB were positive respectively.
Conclusions: The TEG parameters of 3 stages of pregnancy were different. The different ingravidation approach has effect on TEG. The TEG parameters were consistent with conventional coagulation indicators. The TEG can be used to screen the coagulation status of gestational women, recognize the abnormalities of coagulation and prevent the severe complication timely.
目的: 孕产妇数量逐年上升，与凝血功能异常相关的不良妊娠事件增多。对孕妇进行凝血功能评估并及时干预至关重要。本研究旨在分析妊娠期女性血栓弹力图(thrombelastography，TEG)参数的影响因素，探讨TEG指标对孕妇凝血状态的评估作用。方法: 回顾性分析2018年至2020年在中南大学湘雅医院产科住院的449例孕妇的临床资料，对比不同年龄、受孕方式、妊娠阶段的健康孕妇间TEG参数的差异，分析妊娠期高血压疾病(hypertensive disorders in pregnancy，HDP)、妊娠期糖尿病(gestational diabetes mellitus，GDM)及同时合并两种疾病对孕妇TEG各参数的影响。结果: 与中孕组相比，晚孕组孕妇TEG中的R值、K值增加，α角减小，CI值、LY30值减少(均P<0.05)。HDP组与健康组孕妇相比，TEG中R值、CI值的差异均有统计学意义(均P<0.05)。GDM组、同时合并HDP及GDM组与健康组孕妇相比，TEG各项参数的差异均无统计学意义(均P>0.05)。多元线性回归分析显示：TEG中R值的影响因素为妊娠周数(P<0.001)及受孕方式(P<0.05)，α角的影响因素为妊娠周数(P<0.05)，MA值的影响因素为受孕方式(P<0.05)，CI值的影响因素为妊娠周数(P<0.05)。TEG与血小板(platelet，PLT)及常规凝血指标的相关性分析显示：TEG的R值与活化部分凝血活酶时间(activated partial thromboplastin time，APTT)呈正相关(P<0.01)，与CI值呈负相关(P<0.05)；K值与纤维蛋白原(fibrinogen，FIB)呈负相关(P<0.05)；α角(P<0.05)、MA值(P<0.01)及CI值(P<0.05)与FIB呈正相关。结论: 妊娠不同时期TEG各指标存在相应变化，不同受孕方式对TEG参数结果有影响。TEG各参数与常规凝血功能检测的结果相关，且有较好的一致性。TEG可作为凝血功能的评估手段，及时发现孕产妇的异常凝血状态，有利于尽早预防严重并发症的发生。.
Keywords: coagulation function; influencing factors; pregnancy; thrombelastography.