Department of Laboratory Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Laboratory Medicine, Peking University Third Hospital, Haidian District, Beijing, China.
Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029619894057. doi: 10.1177/1076029619894057.
emolysis, levated iver enzymes, and ow latelets (HELLP) syndrome is a serious complication of pregnancy. Postpartum hemorrhage indicates poor prognosis of pregnant women with HELLP syndrome. The aim of our study is to investigate the predictive value of coagulation markers for postpartum hemorrhage of pregnant women with HELLP syndrome. In a retrospective cohort study, 106 patients who were diagnosed as pregnant women with HELLP syndrome in Peking University Third Hospital from August 2010 to January 2017 were analyzed. The demographic characters of maternal and fetus, days of hospital stay, postpartum complications, and the laboratory tests of coagulation markers within 3 days before delivery were collected. In addition, 100 healthy pregnant women were collected as a control group. The result showed that the incidence of preeclampsia in pregnant women with postpartum hemorrhage was higher than that in pregnant women without hemorrhage ( = .011). The level of fibrinogen (FIB) in postpartum hemorrhage pregnant women with HELLP syndrome was lower than that in nonpostpartum hemorrhage pregnant women with HELLP syndrome and healthy pregnant women (2.3 [1.68-2.81] vs 3.64 ± 0.95, = .000; 2.3 [1.68-2.81] vs 4.48 ± 0.62, = .000). Multivariate analysis showed that decreased FIB levels independently predicted the postpartum hemorrhage of pregnant women with HELLP syndrome (odds ratio = 7.374, 95% confidence interval [CI], 1.551-35.05, = .012). The receiver operating characteristic curve showed that the area under the curve of FIB level when predicting postpartum hemorrhage is 0.841 (95% CI, 0.708-0.976). When the cutoff value of FIB was 3.04 g/L, the sensitivity was 90.90% and the specificity was75.80%. Therefore, the low level of prenatal FIB is a reliable biomarker to predict postpartum hemorrhage of pregnant women with HELLP syndrome, which make it useful for pregnant women with HELLP syndrome in guiding surveillance therapy and prognosis assessment.
溶血、肝酶升高和血小板减少（HELLP）综合征是妊娠的严重并发症。产后出血表明 HELLP 综合征孕妇的预后不良。我们的研究目的是探讨凝血标志物对 HELLP 综合征孕妇产后出血的预测价值。在一项回顾性队列研究中，分析了 2010 年 8 月至 2017 年 1 月北京大学第三医院诊断为 HELLP 综合征的 106 例孕妇。收集了产妇和胎儿的人口统计学特征、住院天数、产后并发症以及分娩前 3 天的凝血标志物实验室检查结果。此外，还收集了 100 名健康孕妇作为对照组。结果显示，产后出血孕妇的子痫前期发生率高于无出血孕妇（ =.011）。HELLP 综合征产后出血孕妇的纤维蛋白原（FIB）水平低于非产后出血 HELLP 综合征孕妇和健康孕妇（2.3 [1.68-2.81] vs 3.64 ± 0.95， =.000；2.3 [1.68-2.81] vs 4.48 ± 0.62， =.000）。多变量分析显示，FIB 水平降低独立预测 HELLP 综合征孕妇产后出血（比值比=7.374，95%置信区间[CI]，1.551-35.05， =.012）。FIB 水平预测产后出血的受试者工作特征曲线下面积为 0.841（95%CI，0.708-0.976）。当 FIB 的截断值为 3.04 g/L 时，灵敏度为 90.90%，特异性为 75.80%。因此，产前 FIB 水平低是预测 HELLP 综合征孕妇产后出血的可靠生物标志物，有助于指导 HELLP 综合征孕妇的监测治疗和预后评估。
