Wang Lele, Zhong Junmin, Xiao Du, Huang Wei, Zheng Zheng, Jiang Yanmin
Department of High-Risk Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Ann Transl Med. 2022 Dec;10(23):1273. doi: 10.21037/atm-22-5221.
Detecting the changes of coagulation function in the early stage of postpartum hemorrhage (PPH), which is the leading cause of maternal death, is the key to treatment this serious disease, however, there is less effective assessment methods. Thrombomodulin (TM), thrombin-antithrombin complex (TAT), plasmin-α2-plasmininhibitor complex (PIC), and tissue plasminogen activator-inhibitor complex (t-PAIC) are the new direct indicators for coagulation and fibrinolysis, and considered sensitive molecular markers of the fibrinolytic system changing. The aim of this study was to investigate the changes of these 4 new indicators in the early stage of PPH.
We retrospectively reviewed the new coagulate indicators, TM, TAT, PIC, and t-PAIC, obtained from PPH patients at Guangzhou Women and Children's Medical Center from January 2021 to July 2021. According to the amount of blood loss, the patients were divided into 3 groups: Mild group (blood loss <1,500 mL, n=17), Severe group (blood loss ≥1,500 mL, n=24); another 12 women who did not experience PPH were selected as the Normal group (n=12). The four indicators were measured at the time of PPH happened, or immediately when baby was born in the Normal group, and evaluated for the prediction of PPH.
The t-PAIC level of the Severe group was significantly lower than the other 2 groups (Normal group Mild group Severe group: 13.9±2.0 9.4±1.8 7.5±0.9, P=0.020), and the PIC level was the highest (Normal group Mild group Severe group: 1.1±0.2 2.7±0.8 2.9±0.6, P=0.012). There was no significant difference in TM and TAT among the 3 groups. The odds ratio (OR) value of t-PAIC was 0.822, 95% confidence interval (CI): 0.697-0.970, P=0.020. The area under the curve (AUC) of PIC was 0.5, and t-PAIC was 0.775, the cut-off point was 6.295, the specificity was 75%, and the sensitivity was 75%.
With the increasing of blood loss, t-PAIC decreased gradually, and is associated with severe PPH. This indicator may be a new predictor of PPH, and should be used in the early period of PPH for treatment.
产后出血（PPH）是孕产妇死亡的主要原因，在其早期阶段检测凝血功能变化是治疗这种严重疾病的关键，但目前有效的评估方法较少。血栓调节蛋白（TM）、凝血酶 - 抗凝血酶复合物（TAT）、纤溶酶-α2-纤溶酶抑制物复合物（PIC）和组织型纤溶酶原激活剂 - 抑制剂复合物（t-PAIC）是凝血和纤溶的新直接指标，被认为是纤溶系统变化的敏感分子标志物。本研究旨在探讨这4项新指标在PPH早期阶段的变化。
回顾性分析2021年1月至2021年7月在广州妇女儿童医疗中心收治的PPH患者的新凝血指标TM、TAT、PIC和t-PAIC。根据失血量将患者分为3组：轻度组（失血量<1500 mL，n = 17），重度组（失血量≥1500 mL，n = 24）；另选12例未发生PPH的产妇作为正常组（n = 12）。在PPH发生时或正常组婴儿出生时立即测量这四项指标，并评估其对PPH的预测价值。
重度组的t-PAIC水平显著低于其他两组（正常组、轻度组、重度组：13.9±2.0、9.4±1.8、7.5±0.9，P = 0.020），PIC水平最高（正常组、轻度组、重度组：1.1±0.2、2.7±0.8、2.9±0.6，P = 0.01）。三组间TM和TAT无显著差异。t-PAIC的比值比（OR）值为0.822，95%置信区间（CI）：0.697 - 0.970，P = 0.020。PIC的曲线下面积（AUC）为0.5，t-PAIC为0.775，截断点为6.295，特异性为75%，敏感性为75%。
随着失血量增加，t-PAIC逐渐降低，且与重度PPH相关。该指标可能是PPH的一个新预测指标，应在PPH早期用于指导治疗。
