背景:先兆子痫(PE),产科疾病,仍然是全球孕产妇和婴儿死亡的主要原因之一。在有体育的人中,由于母体炎症反应和免疫功能障碍,凝血-纤溶系统被认为是影响最显著的系统之一.因此,本系统综述和荟萃分析旨在评估凝血酶原时间(PT),凝血酶时间(TT)和活化部分凝血活酶时间(APTT)水平与子痫前期。
方法:本系统综述和荟萃分析按照PRISMA指南进行。与研究相关的文章,2013年7月26日至2023年7月26日,在包括PubMed在内的各种数据库中进行了系统搜索,Scopus,Embase,还有Hinari.使用JoannaBriggs研究所关键评估清单评估了文章的方法学质量。利用Stata版本14.0,采用随机效应模型来估计合并的标准化平均差(SMD)以及相应的95%CIs。I2统计量和CochraneQ检验用于评估异质性,同时进行亚组分析以探索其来源。此外,采用Egger回归检验和漏斗图评估纳入研究的发表偏倚。
结果:共30篇,涉及5,964人(2,883名PE患者和3,081名血压正常的孕妇),包括在这项研究中。PT的总体合并SMD,APTT,PE和正常血压孕妇之间的TT为0.97(95%CI:0.65-1.29,p<0.001),1.05(95%CI:0.74-1.36,p<0.001),和0.30(95%CI:-0.08-0.69,p=0.11),分别。合并的SMD表明,与血压正常的孕妇相比,PE患者的PT和APTT水平显着增加。而PE患者中TT水平的升高无统计学意义。
结论:荟萃分析强调了PE与延长PT和APTT之间的关联。这表明评估凝血参数,如PT,APTT,孕妇的TT可以为评估PE提供易于获得且具有成本效益的临床指标。然而,需要进行多中心纵向研究,以评估其在妊娠各孕周中的有效性.
BACKGROUND: Preeclampsia (PE), an obstetric disorder, remains one of the leading causes of maternal and infant mortality worldwide. In individuals with PE, the coagulation-fibrinolytic system is believed to be among the most significantly impacted systems due to maternal inflammatory responses and immune dysfunction. Therefore, this systematic review and meta-analysis aimed to assess the association of prothrombin time (PT), thrombin time (TT) and activated partial thromboplastin time (APTT) levels with preeclampsia.
METHODS: This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. Articles relevant to the study, published from July 26, 2013, to July 26, 2023, were systematically searched across various databases including PubMed, Scopus, Embase, and Hinari. The methodological quality of the articles was evaluated using the Joanna Briggs Institute critical appraisal checklist. Utilizing Stata version 14.0, a random-effects model was employed to estimate the pooled standardized mean difference (SMD) along with the respective 95% CIs. The I2 statistics and Cochrane Q test were utilized to assess heterogeneity, while subgroup analyses were performed to explore its sources. Furthermore, Egger\'s regression test and funnel plot were employed to assess publication bias among the included studies.
RESULTS: A total of 30 articles, involving 5,964 individuals (2,883 with PE and 3,081 as normotensive pregnant mothers), were included in this study. The overall pooled SMD for PT, APTT, and TT between PE and normotensive pregnant mothers were 0.97 (95% CI: 0.65-1.29, p < 0.001), 1.05 (95% CI: 0.74-1.36, p < 0.001), and 0.30 (95% CI: -0.08-0.69, p = 0.11), respectively. The pooled SMD indicates a significant increase in PT and APTT levels among PE patients compared to normotensive pregnant mothers, while the increase in TT levels among PE patients was not statistically significant.
CONCLUSIONS: The meta-analysis underscores the association between PE and prolonged PT and APTT. This suggests that evaluating coagulation parameters like PT, APTT, and TT in pregnant women could offer easily accessible and cost-effective clinical indicators for assessing PE. However, multicenter longitudinal studies are needed to evaluate their effectiveness across various gestational weeks of pregnancy.