广西医学

目的探究血栓弹力图（TEG）参数、抗中性粒细胞胞质抗体（ANCA）对早发型重度子痫前期（EOSP）患者不良妊娠结局的预测价值。方法纳入98例EOSP患者作为研究对象，均行TEG检查和ANCA水平测定。根据围产期不良妊娠结局发生情况，将98例EOSP患者分为良好结局组和不良结局组。比较两组患者的一般资料、TEG参数及ANCA阳性率。采用多因素Logistic回归模型分析EOSP患者发生不良妊娠结局的影响因素。绘制受试者工作特征（ROC）曲线分析TEG参数、ANCA阳性率对EOSP患者发生不良妊娠结局的预测价值。结果共有36例EOSP患者出现不良妊娠结局，发生率为36.7%。不良结局组患者的反应时间（R）、凝血综合指数（CI）短/低于良好结局组，最大振幅（MA）、ANCA阳性率、收缩压、舒张压、24 h尿蛋白定量（24h UTP）、总胆固醇水平、LDL⁃C水平和HDL⁃C水平高于良好结局组（P<0.05）。多因素Logistic回归分析结果显示，R增加是EOSP患者发生不良妊娠结局的保护因素，MA升高、ANCA阳性、24h UTP升高是EOSP患者发生不良妊娠结局的危险因素（P<0.05）。ROC曲线分析结果显示，R、MA、ANCA阳性单独及三者联合预测EOSP患者发生不良妊娠结局的灵敏度分别为77.80%、75.00%、72.20%、83.30%，特异度分别为79.00%、66.10%、75.80%、88.70%，曲线下面积（AUC）分别为0.788、0.765、0.740、0.896（P<0.05），三者联合预测的AUC大于单一指标预测的AUC（P<0.05）。结论部分TEG参数（R、MA）异常及ANCA阳性与EOSP患者不良妊娠结局相关。R、MA、ANCA阳性对EOSP患者发生不良妊娠结局具有一定的预测效能，且三者联合的预测效能更佳。

Objective To explore the predictive value of thromboelastography (TEG) parameters and antineutrophil cytoplasmic antibody (ANCA) for adverse pregnancy outcomes in patients with early⁃onset severe preeclampsia (EOSP). Methods A total of 98 patients with EOSP were selected as the research subjects, all of whom underwent TEG examination and ANCA level measurement. Based on the occurrence of adverse perinatal pregnancy outcomes, 98 EOSP patients were divided into favorable outcome group or adverse outcome group. General data, TEG parameters, and ANCA positive rate were compared between the two groups. Multivariate Logistic regression model was used to identify factors influencing adverse pregnancy outcomes in EOSP patients. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of TEG parameters and ANCA positive rate for adverse pregnancy outcomes in EOSP patients. Results A total of 36 EOSP patients experienced adverse pregnancy outcomes, with an incidence rate of 36.7%. Compared with the favorable outcome group, the adverse outcome group exhibited shorter reaction time (R) and a lower coagulation index (CI), while higher maximum amplitude (MA), ANCA positive rate, systolic blood pressure, diastolic blood pressure, 24⁃hour urinary total protein (24h UTP) content, as well as total cholesterol, LDL⁃C, and HDL⁃C levels (P<0.05). Multivariate Logistic regression analysis revealed that increased R was a protective factor for adverse pregnancy outcomes in EOSP patients, whereas increased MA, ANCA positive, and elevated 24h UPT content were the risk factors for adverse pregnancy outcomes in EOSP patients (P<0.05). ROC curve analysis demonstrated that the sensitivities of R, MA, ANCA positive for alone and jointly predicting adverse pregnancy outcomes in EOSP patients were 77.80%, 75.00%, 72.20%, and 83.30%, respectively, with specificities of 79.00%, 66.10%, 75.80%, and 88.70%, respectively. The area under the curve (AUC) for each was 0.788, 0.765, 0.740, and 0.896, respectively (P<0.05). The AUC for the combined prediction was greater than that for any single indicator (P<0.05). Conclusion Some abnormal parameter (e.g. R, MA), and ANCA positive are correlated with adverse pregnancy outcomes in EOSP patients. These indicators as abovementioned possess certain predictive performance for such outcomes, and their combination offers superior predictive performance.