血栓弹力图对妊娠期血小板减少症患者产后出血的预测价值

Predictive value of thromboelastography for postpartum hemorrhage in pregnant women with gestational thrombocytopenia

摘要:

目的 探讨血栓弹力图（TEG）对妊娠期血小板减少症患者产后出血的预测价值。方法 回顾性分析2022年6月—2024年6月在邯郸市第一医院就诊的120例妊娠期血小板减少症患者的临床资料。根据是否发生产后出血，将患者分为产后出血组22例和非产后出血组98例。根据产前血小板计数（PLT），将患者分为重度减少组（PLT <50×10⁹/L，15例）、中度减少组（50×10⁹/L≤PLT<75×10⁹/L，54例）及轻度减少组（75×10⁹/L≤ PLT<90×10⁹/L，51例）。比较各组患者的TEG参数，包括R值、K值、α角、MA值和CI值；采用Pearson相关性分析评估PLT与TEG参数的相关性；探讨TEG参数对患者产后出血的预测效能。结果 非产后出血组R值、K值均低于产后出血组（P <0.05），α角、MA值和CI值均高于产后出血组（P <0.05）。重度减少组、中度减少组和轻度减少组的R值、K值、α角、MA值和CI值比较，差异均有统计学意义（P <0.05）。Pearson相关分析结果显示：PLT与R值（r =-0.587，P =0.000）、K值（r =-0.799，P =0.000）均呈负相关，与α角（r =0.624，P =0.000）、MA值（r =0.764，P =0.000）、CI值（r =0.902，P =0.000）均呈正相关。R、K、α角、MA、CI联合检测预测凝血功能的曲线下面积（AUC）为0.853（95% CI：0.782，0.925）、敏感性为86.7%（95% CI：0.651，0.971）、特异性为76.2%（95% CI：0.667，0.845），预测效能最高。R、K、α角、MA、CI联合检测预测产后出血的AUC为0.948（95% CI：0.877，1.000）、敏感性为90.9%（95% CI：0.708，0.989）、特异性为96.9%（95% CI：0.913，0.994），预测效能最高。结论 TEG可作为预测妊娠期血小板减少症患者产后出血的重要工具，联合检测的预测效能最高，可为临床决策提供参考。

Abstract:

Objective To explore the predictive value of thromboelastography (TEG) for postpartum hemorrhage in pregnant women with gestational thrombocytopenia.Methods A retrospective analysis was conducted on 120 patients with gestational thrombocytopenia treated at Handan First Hospital from June 2022 to June 2024. Patients were divided into two groups based on the occurrence of postpartum hemorrhage: the postpartum hemorrhage group (n = 22) and the non-postpartum hemorrhage group (n = 98). Based on prenatal PLT levels, all patients were categorized into three subgroups: severe thrombocytopenia group (PLT < 50×10?/L, n = 15), moderate thrombocytopenia group (50×10?/L ≤ PLT < 75×10?/L, n = 54), and mild thrombocytopenia group (75×10?/L ≤ PLT < 90×10?/L, n = 51). The thromboelastography parameters, including R-time, K-time, α-angle, maximum amplitude (MA), and coagulation index (CI), were compared among patients with different postpartum hemorrhage outcomes and within different platelet count ranges. Pearson correlation analysis was used to assess the relationship between platelet count (PLT) and TEG parameters, and the predictive efficacy of TEG for postpartum hemorrhage was evaluated.Results A comparison of R value, K value, α angle, MA value, and CI value between the non-postpartum hemorrhage group and the postpartum hemorrhage group showed statistically significant differences (P < 0.05). The R value and K value in the non-postpartum hemorrhage group were lower than those in the postpartum hemorrhage group, while the α angle, MA value, and CI value were higher. Comparison of the R value, K value, α angle, MA value, and CI value among severe thrombocytopenia group, moderate thrombocytopenia group, mild thrombocytopenia group by analysis of variance revealed statistically significant differences (P < 0.05). Pearson correlation analysis showed that the PLT level was negatively correlated with the R value (r = -0.587, P = 0.000) and K value (r = -0.799, P = 0.000), and positively correlated with the α angle (r = 0.624, P = 0.000), MA value (r = 0.764, P = 0.000), and CI value (r = 0.902, P = 0.000). In predicting coagulation function, the combined detection of R, K, α angle, MA, and CI yielded the highest diagnostic efficacy, with an AUC of 0.853 (95% CI: 0.782, 0.925), a sensitivity of 86.7% (95% CI: 0.651, 0.971), and a specificity of 76.2% ( 95% CI: 0.667, 0.845). When the combined detection of R, K, α-angle, MA, and CI was used for postpartum hemorrhage, the AUC was 0.948 (95% CI: 0.877, 1.000), sensitivity was 90.9% (95% CI: 0.708, 0.989), specificity was 96.9% (95% CI: 0.913, 0.994), demonstrating the highest diagnostic efficacy.Conclusion TEG is a valuable tool for predicting postpartum hemorrhage in pregnant women with gestational thrombocytopenia. Combined parameter analysis offers the highest diagnostic efficacy and can provide essential guidance for clinical decision-making.