Chu Xiangnan, Wang Wei, Zhang Heping, Feng Qingguo, Peng Yunxiang
Department of Laboratory, the Fifth Center Hospital in Tianjin, Tianjin 300450, China.
Department of ICU, TEDA International Cardiovascular Hospital, Tianjin 300457, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020 Sep;32(9):1121-1124. doi: 10.3760/cma.j.cn121430-20200601-00447.
To investigate the changes and clinical significance of blood coagulation function and von Willebrand factor antigen (vWF:Ag) in patients with HELLP syndrome (hemolysis, elevated liver function, low platelet count).
The clotting data of patients with severe preeclampsia and HELLP syndrome (observation group) admitted to the department of critical care medicine of the Fifth Center Hospital in Tianjin from May 2015 to December 2019 were retrospectively analyzed, and normal late pregnancy women with the same period were enrolled as the control group. The coagulation indexes such as prothrombin time (PT), activated partial thrombin time (APTT), antithrombin (AT), fibrinogen (Fib), D-dimer and plasma vWF:Ag level were compared between the two groups, and among patients with HELLP syndrome with different disease degree.
(1) Sixty-five patients with HELLP syndrome and 65 normal pregnant women with third trimester were included. Both groups were women of childbearing age, and there were no significant difference in the baseline data. (2) The levels of Fib, D-dimer in both groups increased, but they were significantly higher in the observation group than those in the control group [Fib (g/L): 4.94 (4.76, 5.85) vs. 3.58 (2.97, 4.14), D-dimer (mg/L): 3.34 (2.55, 4.32) vs. 1.72 (1.29, 2.08), both P < 0.05], the AT was obviously reduced [62.00 (49.00, 73.00)% vs. 97.50 (90.75, 107.00)%, P < 0.01], and both PT and APTT were in the normal reference range in the two groups. In addition, the plasma vWF:Ag level in the observation group was significantly higher than that in the control group [516.50 (467.20, 563.00)% vs. 246.45 (189.95, 274.10)%, P < 0.01]. (3) According to thrombocytopenia, among the 65 patients with HELLP syndrome, 26 cases were mild [platelet count (PLT) > 100×10/L], 22 cases were moderate [PLT (50-100)×10/L], and 17 cases were severe (PLT < 50×10/L). With the aggravation of the disease, the D-dimer, Fib, vWF:Ag levels in the mild, moderate, severe patients significantly increased, while the AT level significantly decreased, and there was statistically significant difference between the two groups [D-dimer (mg/L): 2.63 (2.60, 2.73), 3.15 (2.55, 3.73), 3.84 (3.52, 4.23); Fib (g/L): 4.23 (4.06, 4.47), 4.72 (4.34, 5.04), 5.43 (5.14, 5.76); vWF:Ag: 465.20 (437.20, 495.40)%, 500.10 (472.40, 534.50)%, 543.50 (521.30, 563.00)%; AT: 67.50 (61.60, 78.00)%, 63.70 (53.30, 70.40)%, 54.40 (44.00, 61.20)%; all P < 0.05].
Patients with HELLP syndrome may show hypercoagulability and excessive expression of peripheral blood vWF:Ag level, which can induce platelet aggregation, leading to thrombocytopenia and thrombotic microangiopathy, and the clinicians should pay attention to that.
探讨溶血、肝酶升高及血小板减少综合征（HELLP综合征）患者凝血功能及血管性血友病因子抗原（vWF:Ag）的变化及其临床意义。
回顾性分析2015年5月至2019年12月天津市第五中心医院重症医学科收治的重度子痫前期及HELLP综合征患者（观察组）的凝血资料，并选取同期正常晚期妊娠妇女作为对照组。比较两组患者的凝血指标，如凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、抗凝血酶（AT）、纤维蛋白原（Fib）、D-二聚体及血浆vWF:Ag水平，并比较不同疾病程度的HELLP综合征患者之间的上述指标。
（1）纳入65例HELLP综合征患者及65例孕晚期正常孕妇。两组均为育龄期女性，基线资料无显著差异。（2）两组Fib、D-二聚体水平均升高，但观察组显著高于对照组[Fib（g/L）：4.94（4.76，5.85）对3.58（2.97，4.14），D-二聚体（mg/L）：3.34（2.55，4.32）对1.72（1.29，2.08），均P<0.05]，AT明显降低[62.00（49.00，73.00）%对97.50（90.75，107.00）%，P<0.01]，两组PT及APTT均在正常参考范围内。此外，观察组血浆vWF:Ag水平显著高于对照组[516.50（467.20，563.00）%对246.45（189.95，274.10）%，P<0.01]。（3）根据血小板减少情况，65例HELLP综合征患者中，轻度26例[血小板计数（PLT）>100×10⁹/L]，中度22例[PLT（50-100）×10⁹/L]，重度17例（PLT<50×10⁹/L）。随着病情加重，轻度、中度、重度患者的D-二聚体、Fib、vWF:Ag水平显著升高，而AT水平显著降低，两组间差异有统计学意义[D-二聚体（mg/L）：2.63（2.60，2.73），3.15（2.55，3.73），3.84（3.52，4.23）；Fib（g/L）：4.23（4.06，4.47），4.72（4.34，5.04），5.43（5.14，5.76）；vWF:Ag：465.20（437.20，495.40）%，500.10（472.40，534.50）%，543.50（521.30，563.00）%；AT：67.50（61.6
