Huissoud Cyril, Carrabin Nicolas, Benchaib Mehdi, Fontaine Oriane, Levrat Albrice, Massignon Denis, Touzet Sandrine, Rudigoz René-Charles, Berland Michel
Department of Obstetrics and Gynecology, Croix Rousse University Hospital, Lyon, Hospices civils de Lyon, France.
Thromb Haemost. 2009 Apr;101(4):755-61.
We analysed changes in coagulation during normal pregnancy with a novel point-of-care device based on thrombelastometry (ROTEM). We compared the results obtained with those of standard coagulation tests in 104 patients: 20 non-pregnant women (controls) and 84 women in the first (T1, n = 17), second (T2, n = 9) and third (T3, n = 58) trimesters of pregnancy. We measured the clotting time (CT), the maximum clot firmness (MCF), the early clot amplitude at 5 and 15 minutes (CA(5), CA(15)) and the clot lysis index (CLI(30)) with four tests containing specific reagents. (a) The INTEM test involving ellagic acid activated the intrinsic pathway and (b) the EXTEM test using tissue factor triggered the extrinsic pathway; (c) The FIBTEM test based on a platelet inhibitor (cytochalasin D) evaluated the contribution of fibrinogen to clot formation and (d) the APTEM test was similar to the EXTEM but was based on inhibition in vitro of fibrinolysis by aprotinin. CT and CLI(30) were not significantly modified during pregnancy whereas MCF, CA(5) and CA(15) (INTEM, EXTEM, FIBTEM) increased significantly between the second and third trimesters (e.g. median [interquartile range]: MCF-FIBTEM, 13 [11-16] mm vs. 19 [17-23] mm, respectively, in controls and T3, p < 0.001). EXTEM values were not significantly different from those measured with APTEM. There were significant correlations between the results obtained with ROTEM and those from standard coagulation tests. ROTEM analysis showed a marked increase in coagulability during normal pregnancy. ROTEM values may serve as the basis for future studies in pregnant women.
我们使用一种基于血栓弹力图（ROTEM）的新型即时检测设备，分析了正常妊娠期间凝血功能的变化。我们将104例患者使用该设备获得的结果与标准凝血试验结果进行了比较，其中包括20名非妊娠女性（对照组）以及84名处于妊娠第一期（T1，n = 17）、第二期（T2，n = 9）和第三期（T3，n = 58）的女性。我们通过四项含有特定试剂的检测，测量了凝血时间（CT）、最大血凝块硬度（MCF）、5分钟和15分钟时的早期血凝块振幅（CA(5)、CA(15)）以及血凝块溶解指数（CLI(30)）。（a）包含鞣花酸的INTEM检测激活内源性途径，（b）使用组织因子的EXTEM检测触发外源性途径；（c）基于血小板抑制剂（细胞松弛素D）的FIBTEM检测评估纤维蛋白原对血凝块形成的贡献，（d）APTEM检测与EXTEM相似，但基于抑肽酶在体外对纤维蛋白溶解的抑制作用。CT和CLI(30)在妊娠期间无显著改变，而MCF、CA(5)和CA(15)（INTEM、EXTEM、FIBTEM）在妊娠第二期和第三期之间显著增加（例如，中位数[四分位间距]：对照组和T3组的MCF-FIBTEM分别为13[11 - 16]mm和19[17 - 23]mm，p < 0.001）。EXTEM值与APTEM测量值无显著差异。ROTEM获得的结果与标准凝血试验结果之间存在显著相关性。ROTEM分析显示正常妊娠期间凝血能力显著增加。ROTEM值可为未来对孕妇的研究提供依据。
