龙岩人民医院肾内科;龙岩人民医院血液内科;龙岩人民医院检验科;龙岩人民医院产科;
目的 妊娠相关血栓性微血管病(P-TMA)是围生期的急危重症，起病急骤突然，常危及母婴安全，治疗手段有限。寻求非创伤性的P-TMA预测方法，对于改善母婴预后具有重要的意义。方法 通过回顾性分析建立预测模型，选用临床诊断P-TMA患者61例，同时选用520例健康孕产妇作为对照，比较两组实验室指标的差异，依据logistic回归，建立P-TMA预测模型。通过前瞻性研究对预测模型进行外部验证。入选28周以上孕产妇志愿者895例，用建立的预测模型进行测算，其中预测阳性67例，阴性828例。随访至产后3个月，验证和评估该预测模型的价值。结果 血小板(PLT)、乳酸脱氢酶(LDH)及血管性血友病因子(vWF)为P-TMA病变的有效预测指标(均P<0.05),并据此建立logistic回归方程。该方程对P-TMA病变的预测概率拟合ROC曲线，AUC为0.997(P<0.001)。Hosmer-Lemeshow检验的拟合度良好(P=0.986)。在895例志愿者中进行的前瞻性外部验证，AUC为0.830(P<0.001),预测阳性到临床诊断的时间间隔为(11±6.5)d,提示该模型对P-TMA具有良好的预测功能。结论 基于PLT、LDH及vWF建立的无创性的P-TMA预测模型，临床易开展，可有效对P-TMA患者早期预警，改善母婴预后。
| 154 | 0 | 35 |
| 下载次数 | 被引频次 | 阅读次数 |
[2] Salhab M,Hsu A,Ryer E,et al.Microangiopathic hemolytic anemia in pregnancy [J].Transfus Apher Sci,2017,56(3):354-356.
[3] Ataullakhanov FI,Koltsova EM,Balandi-na AN,et al.Classic and global hemostasis testing in pregnancy and during pregnancy complications[J].Semin Thromb Hemost,2016,42(7):696-716.
[4] Fakhouri F,Scully M,Provot F,et al,Management of thrombotic microangiopathy in pregnancy and postpartum:report from an international working group [J].Blood,2020,136(19):2103-2117.
[5] Scully M,Yarranton H,Liesner R,et al.Regional UK TTP registry:correlation with laboratory ADAMTS 13 analysis and clinical features[J].Br J Haematol,2008,142(5):819-826.
[6] Gupta M,Feinberg BB,Burwick RM.Thrombotic microangiopathies of pregnancy:differential diagnosis [J].Pregnancy Hypertens,2018,12(8):29-34.
[7] 张涛，梁少姗，谌达程，等.血栓性微血管病血清标志物诊断方法的建立与评估[J].肾脏病与透析肾移植杂志，2014,23(2):108-114.
[8] Besbas N,Karpman D Landau D,et al.A classification of hemolytic uremic syndrome and thrombotic thrombocytopenic purpura and related rdisorders [J].Kidney Int,2006,70 (3):423-431.
[9] M?rtzell M,Berlin G,Nilsson T,et al.Thrombotic microangiopathy[J].Transfus Apher Sci,2011,45(2):119-123.
[10] Fakhouri F,Roumenina L,Provot F,et al.Pregnancy-associated hemolytic uremic syndrome revisited in the era of complement gene mutations[J].J Am Soc Nephrol,2010,21(5):859-867.
[11] Ferraro PM,Lombardi G,Naticchia A,et al.A STARD-compliant prediction model for diagnosing thrombotic microangiopathies[J].J Nephrol,2018,31(3):405-410.
[12] Wang X,Zhao J,Zhang Y,et al.Kinetics of plasma von Willebrand factor in acute myocardial infarction patients:a meta-analysis[J].Oncotarget,2017,8(52):90371-90379.
[13] Aref S,Goda H.Increased VWF antigen levels and decreased ADAMTSl3 activity in preeclampsia[J].Hematology,2013,18(4):237-241.
[14] Maki M,Kobayashi T,Terao T,et al.Antithrombin therapy for severe preeclampsia:results of a double-blind,randomized,placebo-controlled trial.B151.017 Study group [J].Thromb Haemost,2000,84(4):583-590.
[15] Shreeve NE,Barryj A,Deutsch LR,et al.Changes in thromboelastography parameters in pregnancy,labor,and the immediate postpartum period[J].Int J Gynaecol Obstet,2016,134(3):290-293.
[16] Khong TY,Mooney EE,Ariel I,et al.Sampling and definitionsof placental lesions:amsterdam placental workshop groupConsensus statement[J].Arch Pathol Lab Med,2016,140(7):698-713.
[17] Hovinga JA,Vesel YSK,Terrell DR,et al.Survival and relapse in patients with thrombotic thrombocytopenic purpura[J].Blood,2010,115(8):1500-1511.
基本信息:
DOI：10.19829/j.zgfybj.issn.1001-4411.2024.15.002
中图分类号:R714.252
引用信息:
[1]谢祖刚,黄冬连,张春春等.妊娠相关血栓性微血管病预测模型的建立与验证[J].中国妇幼保健,2024,39(15):2784-2790.DOI:10.19829/j.zgfybj.issn.1001-4411.2024.15.002.
基金信息:
福建省龙岩市科技项目(2020LYF17019)