凝血功能随孕周及年龄的变化及其参考值  

Comparison of four-coagulation-tests values in normal pregnant women during early and late pregnancy and the influence of age

作　　者：张启迪 魏玉梅[1] 刘兴会 乔宠[3] 顾蔚蓉 赵扬玉[5] 杨慧霞[1] Zhang Qidi;Wei Yumei;Liu Xinghui;Qiao Chong;Gu Weirong;Zhao Yangyu;Yang Huixia(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus,Beijing 100034,China;Department of Obstetrics and Gynecology,West China Second University Hospital,Sichuan University,Chengdu 610041,China;Department of Obstetrics and Gynecology,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Obstetrics,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China;Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100083,China)

机构地区：[1]北京大学第一医院妇产科妊娠合并糖尿病母胎医学北京市重点实验室,北京100034 [2]四川大学华西第二医院妇产科,成都610041 [3]中国医科大学附属盛京医院妇产科,沈阳110004 [4]复旦大学附属妇产科医院产科,上海200011 [5]北京大学第三医院妇产科,北京100083

出　　处：《中华妇产科杂志》2022年第10期740-745,共6页Chinese Journal of Obstetrics and Gynecology

基　　金：国家重点研发计划(2016YFC1000402);国家自然科学基金(81801467)。

摘　　要：目的探讨正常孕妇妊娠早期、妊娠晚期凝血四项的参考值范围,并分析年龄对其影响。方法收集并分析2017年2月至2020年7月于北京大学第一医院、复旦大学附属妇产科医院、四川大学华西第二医院、北京大学第三医院和中国医科大学附属盛京医院单胎分娩的4974例孕妇妊娠早期、妊娠晚期的凝血四项检查结果,包括凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)及凝血酶时间(TT)。以其中2322例无并发症的正常孕妇妊娠早期、妊娠晚期凝血四项检查结果的第2.5~97.5百分位数为本研究的参考值范围,分析高龄对其影响,比较此参考值范围与正常非孕妇女正常值的差异,分析相应范围妊娠并发症的发生率。结果2322例无并发症孕妇妊娠早期、妊娠晚期的PT参考值范围分别为10.0~13.9、9.6~12.3 s,APTT参考值范围分别为22.6~35.3、22.4~30.9 s,Fib参考值范围分别为2.4~5.0、3.0~5.7 g/L,TT参考值范围分别为12.0~19.0、11.5~18.4 s。与妊娠早期比较,妊娠晚期PT、APTT和TT显著缩短,而Fib显著升高(P均<0.001)。2322例正常孕妇中,非高龄孕妇妊娠早期PT、APTT及妊娠晚期APTT均长于高龄孕妇;其妊娠早期TT及妊娠晚期PT、TT均短于高龄孕妇;分别比较,差异均有统计学意义(P均<0.01)。4974例孕妇中,与非孕妇女正常值范围纳入的孕妇相比,本研究妊娠早期PT、妊娠早期和妊娠晚期APTT的参考值范围纳入的孕妇例数更多,而妊娠并发症的发生率无显著差异(P均>0.05);妊娠晚期PT参考值范围内胎儿窘迫的发生率更高而早产发生率较低;妊娠早期Fib参考值范围内的孕妇妊娠期糖尿病发生率较高,妊娠晚期Fib参考值范围内的孕妇妊娠期糖尿病、妊娠期高血压疾病的发生率均较高(P均<0.05)。结论孕妇凝血功能随着孕周增长显著增强,且高龄和非高龄孕妇间存在显著差异。正常孕妇妊娠早期、妊娠晚期PT参考值Objective To explore and compare the reference ranges of four coagulation tests in normal pregnant women during early and late pregnancy and the influence of age.Methods Values of four coagulation tests from 4974 pregnant women,who gave single birth at Peking University First Hospital,Obstetrics and Gynecology Hospital of Fudan University,West China Second University Hospital,Peking University Third Hospital and Shengjing Hospital of China Medical University from February 2017 to July 2020,were measured and analyzed in this study,including prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib)and thrombin time(TT).The four normal reference ranges of coagulation during early and late pregnancy phases were expressed as P2.5-P97.5.The difference of two pregnancy phases was compared by non-parametric test of two related samples.And the difference between pregnant women of advanced and non-advanced age in the same pregnancy phase was compared by independent sample non-parametric test.Chi-square test was used to compare the incidence of pregnancy complications in different coagulation reference ranges.Results The reference ranges of PT of normal pregnant women′s early and late pregnancy were 10.0-13.9 s and 9.6-12.3 s,the reference ranges of APTT were 22.6-35.3 s and 22.4-30.9 s,the reference ranges of Fib were 2.4-5.0 g/L and 3.0-5.7 g/L,the reference ranges of TT were 12.0-19.0 s and 11.5-18.4 s.Compared with early pregnancy,PT,APTT and TT shortened significantly,while the Fib significantly increased in late pregnancy(all P<0.001).PT,APTT and TT of advanced and non-advanced age pregnant women were significantly different(all P<0.01).Compared with the ranges of non-pregnant population,more pregnant women were included in the normal pregnant reference ranges of PT in early pregnancy and APTT in the early and late pregnancy,while the incidence of pregnancy complications had no significant differences(all P>0.05).The incidence of fetal distress was higher and the incidence of preterm birth was

关 键 词：凝血酶原时间 部分促凝血酶原时间 纤维蛋白原 凝血酶时间 妊娠 妊娠并发症 年龄因素 

分 类 号：R714[医药卫生—妇产科学]