不同妊娠结局的孕妇产前静脉血浆D-二聚体浓度变化及相关性研究  

The associated studies of D-dimer concentration of patients with different pregnancy outcomes at antepartum

作　　者：王欲[1] 杜鹃[1] 

机构地区：[1]中国医科大学附属盛京医院妇产科,沈阳110004

出　　处：《现代妇产科进展》2011年第9期714-717,共4页Progress in Obstetrics and Gynecology

摘　　要：目的:初步探讨不同妊娠结局的孕妇产前外周静脉血浆D-二聚体(DD)浓度的变化。方法:422例不同妊娠结局的孕妇分为17组,比较各组产前母体DD浓度的差异;分析DD浓度与年龄、孕周、血细胞计数、凝血功能、肝脏功能等指标的相关性。结果:154例健康足月孕妇的DD浓度高于健康成人的截断值(P=0.002);妊娠并发DIC、双胎、死胎等3组患者的DD浓度无统计学差异(P=0.337),均高于健康足月孕妇(P=0.016,0.000,0.001);其余14组孕妇DD浓度无统计学差异(P=0.735)。DD与凝血功能(TT、PT、PTA、APTT)、孕周存在直线关系,与年龄、血细胞计数、肝脏功能等无直接相关,多元回归模型为DD=-11004.4+193.818TT+582.595PT+2009.9PTA+37.416APTT-36.363×(孕周),复相关系数为0.658,P=0.000。结论:产前母体DD基础水平升高,DD筛查产前凝血与纤溶异常需要新的截断值;妊娠并发DIC、双胎、死胎患者DD浓度进一步上升,需密切关注血液纤溶变化;DD浓度与凝血功能相关,产前血液高凝常伴随纤溶增强。Objective：To study the changes of maternal D-dimer concentration at antepartum.Methods：Third trimester pregnant women（n=422）were divided into 17 groups according to different pregnancy outcomes.We calculated the differentiation of D-dimer between each group,and analysed the correlation between D-dimer concentration and maternal age,gestational weeks,blood count,coagulation function,liver function.Results：The D-dimer concentration of healthy full-term pregnant women（n= 154）were higher than the cutoff value of health adult（P=0.002）.There was no statistically difference among pregnancy complicated by DIC,twin pregnancy and fetal death（P was 0.337）,any of which was high than healthy full-term group（P =0.016,0.000,0.001 separately）;no statistically difference among the other 14 study groups（P=0.735）.There was linear relationship between D-dimer and TT,PT,PTA,APTT,gestational weeks;and no linear relationship between D-dimer and maternal age,blood count,liver function,multiple regression equation is DD=-11004.4＋193.818TT＋582.595PT＋2009.9PTA＋37.416APTT-36.363（gestational weeks）,multiple correlation coefficient was 0.658,P was 0.000.Conclusions：Basal level of D-dimer concentration at antepartum is increased,and new cutoff value for screening abnormal coagulation at antepartum is needed.Patients with pregnancy complicated by DIC,twin pregnancy,fetal death appear a higher D-dimer level.Maternal D-dimer concentration at antepartum correlates with coagulation function,and prenatal hypercoagulability is associated with enhanced fibrinolysis probably.

关 键 词：D-二聚体 纤维蛋白溶解 弥漫性血管内凝血 产前诊断 

分 类 号：R714.14[医药卫生—妇产科学]