| Objective:The purpose of this study was to analyze the parameters of thromboelasmogram（TEG）and platelet count（PLT）in normal pregnant women and patients with hypertension during pregnancy through retrospective case control study.To study the variation trend of TEG parameters and PLT in normal pregnant women and pregnant women with hypertension during pregnancy.To study the predictive value of TEG parameters and PLT as potential markers of hypertension during pregnancy.Methods:A retrospective case-control study was conducted on 215 pregnant women who were given birth in the outpatient department of obstetrics of sichuan provincial people’s hospital from January 1,2018 to June 1,2019 and met the inclusion criteria.There were120 normal pregnant women in group A.32 patients with gestational hypertension were assigned to group B.35 patients with preeclampsia were assigned to group C.28 patients with severe preeclampsia were assigned to group D.TEG parameters（R value,K value,mean Angle,MA value,CI value）,PLT and hemoglobin（HGB）were detected in four groups of pregnant women.According to the standard of Polak et al.[1],TEG parameters and PLT results in the first trimester（10-13+6 weeks）and the third trimester（30-38weeks）of the normal pregnancy group were compared,and the actual reference range of TEG in different trimester weeks of the normal pregnant women in our hospital was analyzed.The general information(age,BMI,number of smokers,number of pregnancies,number of deliveries,mean systolic blood pressure（20 weeks before gestation）and mean diastolic blood pressure（20 weeks before gestation）of the four groups were compared.The differences of TEG parameters,PLT and HGB in the first trimester（gestation 10-13+6 weeks）and the third trimester（gestation 30-38 weeks）of the four groups were compared.The differences of TEG parameters,PLT and HGB in early and late pregnancy were compared among the 4 groups.MedCalc was used to calculate the area under the ROC curve and related parameters（sensitivity,specificity and yoden index）.Finally,multivariate logistic regression analysis was used to test the predicted value of each indicator.Result:1.For body weight,group D was larger than group A,group B and group C（P<0.05）,while pairwise comparison between group A,group B and group C showed no significant difference（P>0.05）.For BMI,group D was larger than group A and group B（P<0.05）,and group C was larger than group A（P<0.05）.There was no significant difference in BMI between group D and group C（P>0.05）,while there was no significant difference between group A and group C and group B（P>0.05）.2.In the first and third trimester of pregnancy,the actual range of thrombelastography parameters was different from the reference range of healthy pregnant women,and the difference was not statistically significant（P<0.05）.3.In early pregnancy,the R value of group D was higher than that of the other three groups（P<0.05）.The value of digital Angle,MA,CI and PLT in group D was lower than that of the other three groups（P<0.05）.Compared with group A,group B and group C showed gradually decrease in R value and PLT,and gradually increase in the Angle,MA value and CI value with the aggravation of the disease,showing no significant difference between the two groups（P>0.05）.4.In the third trimester,the R value of group D was higher than that of the other three groups（P<0.05）.The value of digital Angle,MA,CI and PLT in group D was lower than that of the other three groups（P<0.05）.Compared with group A,there was no significant difference in parameters between group A and group B（P>0.05）.The value of digital Angle,MA and CI in group C was higher than that in group A（P<0.05）.5.Compared with late pregnancy,the R,K and PLT values of late pregnancy in group A were lower than those in early pregnancy（P<0.05）,and the digital Angle,MA and CI values were higher than those in early pregnancy（P<0.05）.In group B,R,K and PLT values in late pregnancy were lower than those in early pregnancy（P<0.05）,and the digital Angle and CI values were higher than those in early pregnancy（P<0.05）.In group C,the R value of late pregnancy was lower than that of early pregnancy（P<0.05）,and the Angle,MA value and CI value were higher than that of early pregnancy（P<0.05）.The incidence Angle,MA and CI of D group were higher than those of D group（P<0.05）.6.In the preeclampsia group,the area under the ROC curve of PLT and BMI was0.615（0.534-0.692）and 0.647（0.566-0.722）,respectively,which had diagnostic value（P<0.05）.The diagnostic cutoff values were 180 and 24.44,the sensitivity was 0.60 and0.51,the specificity was 0.63 and 0.75,and the yoden index was 0.23 and 0.26,respectively.The diagnostic parameters found by ROC analysis were included in logistic regression analysis,and BMI was found to be statistically significant（P<0.05）.7.In the severe preeclampsia group,the area under the curve of R value,Angle of incidence,MA value,CI value,PLT and BMI were 0.672（0.590-0.746）,0.713（0.634-0.784）,0.714（0.635-0.784）,0.758（0.681-0.823）,0.699（0.619-0.771）and 0.748（0.671-0.815）,respectively,which had diagnostic value（P<0.05）.The diagnostic cutoff values were 5.5,70.4,65.4,-0.6,196 and 25.84,the sensitivity was 0.74,1,0.74,0.55,0.84 and 0.55,the specificity was 0.53,0.35,0.69,0.95,0.53 and 0.85,and the yoden index was 0.27,0.35,0.43,0.50,0.37 and 0.40,respectively.The diagnostic parameters found by ROC analysis were included in logistic regression analysis,and CI,PLT and BMI of early pregnancy were found to be statistically significant（P<0.05）.Conclusion:1.Normal pregnancy causes maternal physiological hypercoagulability in the late pregnancy,and TEG can effectively identify the coagulation status.2.TEG can effectively monitor the progress of patients with Prethrombotic status in hypertensive disorder of pregnancy,which is of great significance to reduce maternal and infant complications.3.BMI and the coagulation index（CI）measured by TEG was an early indicator of severe preeclampsia,and the best diagnostic points were>25.84 and<-0.6,respectively.4.BMI was an independent risk factor for preeclampsia and severe preeclampsia... |
PDF Full Text Request