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目的分析妊娠期合并静脉血栓栓塞性疾病(venous thromboembolism,VTE)的危险因素及临床特点。方法将1995~2015年广东医科大学附属医院收治的妊娠期合并VTE的患者48例作为VTE组,并将其根据发病孕周分为3个亚组(<12周组14例,12周~28周组17例,>28周组17例);采用1:2配比病例对照分析的方法,选择同期产检、住院分娩且无产科合并症与并发症的正常孕妇96例为对照组。采用logistic回归分析方法比较两组产检及住院分娩的病历资料。结果 (1)VTE组孕次多于对照组、体重增长幅度大于对照组,红细胞(erythrocyte,RBC)、血红蛋白(hemoglobin,Hb)、血红蛋白压积(hematocrit,HCT)低于对照组,差异均有统计学意义(P<0.05);(2)凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、D-二聚体(D-Dimer)、纤维蛋白原(fibrinogen,FIB)水平比较差异无统计学意义(P>0.05);(3)VTE亚组分析发现:随着孕周的增加,RBC、HB、HCT、PT、APTT等指标均有下降趋势,D-Dimer、FIB均有升高趋势,但不同亚组间两两比较差异无统计学意义(P>0.05);(4)单因素分析结果显示:孕次,体重增长幅度,Hb、HCT、RBC低,稽留流产病史,妊娠期高血压疾病是VTE形成的危险因素。多因素回归分析结果显示:稽留流产病史是VTE发病的独立危险因素。结论稽留流产病史是妊娠期合并VTE发病的独立危险因素之一,而妊娠期的Hb、HCT、RBC减低对于VTE的发生可能具有早期预测价值。
Objective To analyze the risk factors and clinical features of venous thromboembolism (VTE) during pregnancy. Methods Forty-eight patients with VTE during pregnancy admitted to the Affiliated Hospital of Guangdong Medical University from 1995 to 2015 were selected as VTE group and were divided into 3 subgroups according to their gestational age (<12 weeks, 14 cases, 12 weeks to 28 years) Week group, 17 cases, 17 weeks> 28 weeks group). The control group consisted of 96 normal pregnant women who did not have obstetric complications and complications in the same period. Logistic regression analysis was used to compare the medical records of the two groups during childbirth and hospitalization. Results (1) Compared with the control group, the weight gain of VTE group was more than that of the control group. The erythrocyte (RBC), hemoglobin (Hb) and hematocrit (HCT) (P <0.05); (2) Prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer (3) The subgroup analysis of VTE showed that the indexes of RBC, HB, HCT, PT, APTT decreased with the increase of gestational age. There was no significant difference in fibrinogen (FIB) (P> 0.05). (4) The results of univariate analysis showed that the pregnancy rate, weight gain, Hb, HCT, RBC low, missed history of abortion, hypertensive disorder of pregnancy is a risk factor for the formation of VTE. Multivariate regression analysis showed that the history of missed abortion was an independent risk factor for the onset of VTE. Conclusions The history of missed abortion is one of the independent risk factors for the occurrence of VTE during pregnancy. However, the reduction of Hb, HCT and RBC during pregnancy may have early predictive value for the occurrence of VTE.