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目的溶血、肝酶升高及血小板减少(hemolysis,elevated liver enzymes,low platelets,HELLP)综合征患者凝血指标及肿瘤坏死因子(tumor necrosis factor,TNF)-α的变化及其相关性研究。方法选取2014年2月至2015年8月在成都市妇女儿童中心医院接受治疗的子痫前期120例患者的病例资料,根据其是否合并HELLP分为合并HELLP组(42例)和未合并HELLP组(78例),分析两组患者凝血指标及TNF-α等炎症细胞因子水平的差异和相关性。结果合并HELLP组患者的纤维蛋白原(fibrinogen,FIB)、D-二聚体(D dimer,D-D)水平明显高于未合并HELLP组,两组患者的活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶原时间(prothrombin time,PT)和凝血酶时间(thrombin time,TT)比较差异无统计学意义(P>0.05);合并HELLP组患者的白介素-6(interleukin,IL-6)、超敏反应C蛋白(hypersensitive c-reactive protein,hs-CRP)和TNF-α水平明显高于未合并HELLP组(P<0.05);IL-6、hs-CRP和TNF-α水平与FIB、D-D水平正相关(r值=0.582、0.498,0.602、0.517,0.465、0.386,P均<0.05),而与APTT、PT和TT无明显相关关系(P>0.05)。结论 HELLP患者FIB、D-D、IL-6、hs-CRP和TNF-α水平较高,可作为临床监测指标。
Objective To study the changes of coagulation index and tumor necrosis factor (TNF) -α in patients with hemolysis, elevated liver enzymes and low platelets syndrome (HELLP) syndrome and their correlation. Methods The data of 120 cases of preeclampsia who were treated in Chengdu Women and Children’s Hospital from February 2014 to August 2015 were divided into HELLP group (n = 42) and non-HELLP group according to whether they were complicated with HELLP or not (78 cases). The differences and correlations between coagulation indexes and levels of inflammatory cytokines such as TNF-α in two groups were analyzed. Results The levels of fibrinogen (FIB) and D dimer (DD) in HELLP group were significantly higher than those in HELLP group. The activated partial thromboplastin time , APTT), prothrombin time (PT) and thrombin time (TT), there was no significant difference (P> 0.05). Interleukin-6 (P <0.05). The levels of hs-CRP and TNF-αwere significantly higher than that of HELLP group (P <0.05). The levels of hs-CRP and TNF- (R = 0.582,0.498,0.602,0.517,0.465,0.386, P <0.05), but no significant correlation with APTT, PT and TT (P> 0.05). Conclusion HELLP patients with higher levels of FIB, D-D, IL-6, hs-CRP and TNF-α, can be used as clinical monitoring indicators.