孕期及产褥早期妇女血浆D-二聚体水平的变化  

Study on the dynamic changes of D-dimer during pregnancy and early puerperium

作　　者：徐冬[1] 蔡淑萍[1] 徐静薇[1] 梁琤[1] 贺晶[1] 

机构地区：[1]浙江大学医学院附属妇产科医院产科,杭州310006

出　　处：《中华妇产科杂志》2016年第9期666-671,共6页Chinese Journal of Obstetrics and Gynecology

基　　金：浙江省医药卫生科技计划（2015KYB204）

摘　　要：目的：探讨孕期及产褥早期（产后3d内）妇女血浆D-二聚体水平的变化趋势。方法选取2007年1月至2014年12月在浙江大学医学院附属妇产科医院足月分娩的健康单胎孕妇8367例进行回顾性分析，收集孕妇孕期及产褥早期各时间点检测的血浆D-二聚体水平，共完成血浆D-二聚体水平检测21065例次，按检测时间点不同分为5组：早孕组（≤12周）、中孕组（〉12～28周）、晚孕组（〉28周）、产后1组（产后48 h内）、产后2组（产后48～72 h）。比较5组孕妇的血浆D-二聚体水平，计算各组孕妇的血浆D-二聚体水平的95%CI。比较不同分娩方式孕妇产后血浆D-二聚体水平；分析发生血栓栓塞性疾病孕妇血浆D-二聚体水平。正常人群血浆D-二聚体水平为≤0.5 mg/L。结果（1）早孕组、中孕组、晚孕组、产后1组、产后2组5组孕妇血浆D-二聚体水平均明显高于正常人群水平（P〈0.01）；但早孕组与晚孕组孕妇血浆D-二聚体水平比较，差异无统计学意义（P=0.820）；产后1组孕妇血浆D-二聚体水平均明显高于早孕组及晚孕组（P〈0.01）；产后2组血浆D-二聚体水平明显低于早孕组、晚孕组及产后1组（P〈0.01）。（2）孕妇孕期血浆D-二聚体水平的95%CI分别为：早孕组为0.58～8.28 mg/L、晚孕组为0.47～11.52 mg/L。（3）剖宫产分娩孕妇血浆D-二聚体水平均显著高于阴道分娩孕妇（P〈0.01）。阴道分娩者产后48 h内D-二聚体水平95%CI为1.04～9.59 mg/L、48～72 h为0.87～5.22 mg/L；剖宫产者产后48 h内95%CI为1.07～11.58 mg/L、48～72 h为1.00～6.23 mg/L。（4）8367例孕妇中，6例发生血栓栓塞性疾病，其产后48 h内的血浆D-二聚体水平为6.89～19.89 mg/L，平均为13.66 mg/L，均高于正常人群水平（P〈0.01）。4例下肢静脉血栓孕妇中，3例产后48 h内血浆D-二聚体水平分别为9.77、8.65、6.89 mg/L，均为剖宫产分娩，均在剖宫产人群9Objective To explore the dynamic changes of D-dimers during pregnancy and early puerperium （within 3 days postpartum）. Methods A retrospective study was performed among 8 367 healthy women who had term singleton delivery in Women′s Hospital, School of Medicine, Zhejiang University from January 2007 to December 2014. D-dimers concentrations during pregnancy and early puerprium of all the cases were collected. Data of 21 065 D-dimers tests were assigned to 5 groups according to the time of sampling, including early pregnancy （≤12 gestation weeks）, middle pregnancy （12-28 gestation weeks）, late pregnancy （〉28 gestation weeks）, 1 postpartum （within 48 hours postpartum） and 2 postpartum （48-72 hours postpartum）. The D-dimers concentrations in different groups were compared. The effect of＆nbsp;delivery mode on D-dimers of early pureperium was analyzed. The correlation between D-dimers and the thromboembolic disease was also explored. In this study, Student′s t-test and Wilcoxon rank sum test were used for statistical analysis. D-dimers concentration≤0.5 mg/L was used as the normal range. Results （1） D-dimers concentrations during pregnancy were higher than the non-pregnant women （P〈0.01）, but there was no statistical difference between early pregnancy and late pregnancy （P=0.820）. D-dimers concentration in the 1 postpartum group was higher than that of early pregnancy group or late pregnancy group （P〈0.01）. But in the 2 postpartum group, it was lower than early pregnancy, late pregnancy and 1 postpartum groups. （2）D-dimers in cesarean section cases was significantly higher than in vaginal delivery cases in each period of pregnancy and early pueprium.（3）The 95%CI of D-dimers in early pregnancy, late pregnancy, 48 hours after vaginal delivery, 48-72 hours after vaginal delivery, ≤48 hours after cesarean section, 48-72 hours after cesarean section were 0.58-8.28, 0.47-11.52, 1.04-9.59, 0.87-5.22, 1.07-11.58 and 1.00-6.23 mg/L, respectively.（4）In 6 cases

关 键 词：妊娠 产后期 纤维蛋白纤维蛋白原降解物 

分 类 号：R714[医药卫生—妇产科学] R446.11[医药卫生—临床医学]