产前D-二聚体水平与子痫前期并发产后出血的关系  

Relationship between prenatal D-dimer level and postpartum hemorrhage in patients with preeclampsia

作　　者：刘倩[1] 孙波[1] 梁婵玉 朱燕莉[2] 赵卫华[1] Liu Qian;Sun Bo;Liang Chanyu;Zhu Yanli;Zhao Weihua(Department of Obstetrics,Shenzhen Second People′s Hospital,Shenzhen 518035,China;Department of Obstetrics,Hechi People′s Hospital,Hechi 547000,China)

机构地区：[1]深圳市第二人民医院产科,深圳518035 [2]河池市人民医院产科,河池547000

出　　处：《中国医师杂志》2022年第9期1349-1353,共5页Journal of Chinese Physician

基　　金：深圳市科技计划项目(JCYJ20180228163459314,JCY20170817172241688)。

摘　　要：目的探讨产前D-二聚体水平与子痫前期并发产后出血(PPH)之间的关系。方法回顾性分析2016年1月至2020年12月河池市人民医院340例子痫前期孕妇的临床资料,根据是否发生PPH分为子痫前期并发PPH组(PPH组,57例)和子痫前期未并发PPH组(非PPH组,283例),分析两组孕妇一般临床资料、分娩前血常规和凝血功能参数,比较两组孕妇的差异性。采用logistic回归分析探讨D-二聚体与子痫前期并发PPH的关系,同时量化D-二聚体水平对子痫前期患者发生PPH的影响,并用受试者工作特征(ROC)曲线分析D-二聚体水平对子痫前期并发PPH的预测价值。结果PPH组分娩前白细胞计数、D-二聚体水平高于非PPH组(均P<0.05),而血小板计数、纤维蛋白原水平低于非PPH组(均P<0.05),两组血红蛋白及活化部分凝血活酶时间水平差异均无统计学意义(均P>0.05)。多因素logistic回归分析显示D-二聚体水平升高是子痫前期患者发生PPH的独立危险因素(OR=1.150,95%CI:1.076~1.230,P<0.001),当D-二聚体≥2.16μg/ml时,子痫前期患者发生PPH的风险增加2.904倍(OR=3.904,95%CI:1.705~8.939,P=0.001);在产次≥3次的子痫前期患者中,D-二聚体预测PPH发生的AUC为0.851,特异度为60.78%,灵敏度为100%。结论产前D-二聚体水平升高是子痫前期患者发生PPH的独立危险因素,D-二聚体每增加一个单位,子痫前期患者发生PPH的风险增加0.15倍,D-二聚体在产次≥3次的子痫前期患者中对PPH的发生具有较高的预测价值。Objective To investigate the relationship between prenatal D-dimer level and preeclampsia complicated with postpartum hemorrhage(PPH).Methods The clinical data of 340 preeclampsia pregnant women in Hechi People′s Hospital from January 2016 to December 2020 were retrospectively analyzed.According to whether PPH occurred,they were divided into preeclampsia complicated with PPH group(PPH group,57 cases)and uncomplicated PPH group(non PPH group,283 cases).The general clinical data,blood routine and coagulation function parameters before delivery of the two groups were analyzed,and the differences between the two groups were compared.Logistic regression analysis was used to investigate the relationship between prenatal D-dimer level and preeclampsia complicated with PPH.Meanwhile,the influence of D-dimer level on the occurrence of PPH in preeclampsia patients was quantified.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of D-dimer level on preeclampsia complicated with PPH.Results Compared with non-PPH group,PPH group had higher white blood cell counting and D-dimer levels(P<0.05),and lower levels of platelet count and fibrinogen(all P<0.05);there were no significant difference in the levels of hemoglobin and activated partial thrombin time(APTT)between the two groups(all P>0.05).Multivariate logistic regression analysis showed that elevated D-dimer level was an independent risk factor for PPH in preeclampsia patients(OR=1.150,95%CI:1.076-1.230,P<0.001).When D-dimer≥2.16μg/ml,the risk of PPH in preeclampsia patients increased by 2.804 times(OR=3.904,95%CI:1.705-8.939,P=0.001).In patients who delivered three times or more,D-dimer predicted the occurrence of PPH with an AUC of 0.851,specificity of 60.78%,and sensitivity of 100%.Conclusions Elevate D-dimer level is an independent risk factor for preeclampsia complicated with PPH.When the D-dimer level increased by 1 unit,the risk of PPH in preeclampsia patients increased by 0.15 times.D-dimer has a high predictive value for the

关 键 词：先兆子痫 产后出血 D-二聚体 

分 类 号：R714.244[医药卫生—妇产科学] R714.461[医药卫生—临床医学]