复发性流产患者孕期D-D二聚体、叶酸和凝血功能指标预测自然流产价值  

Prediction value of the levels of D dimer,folic acid,and coagulation function indexes during pregnancy for recurrent spontaneous abortion

作　　者：刘芳 卢宗杰[1] 牟燕[1] 吴金虹 张莎莎 LIU Fang;LU Zongjie;MOU Yan;WU Jinhong;ZHANG Shasha(Suining Central Hospital,Suining,Sichuan Province,629000)

机构地区：[1]四川省遂宁市中心医院,629000

出　　处：《中国计划生育学杂志》2022年第12期2840-2843,共4页Chinese Journal of Family Planning

摘　　要：目的:研究复发性流产(RSA)孕妇孕期二聚体、叶酸和凝血功能指标联合检测对自然流产发生的预测价值。方法:选取2020年1月-2022年1月于本院就诊的RSA早孕患者52例,根据孕14周内是否发生流产分为未流产组(30例)和流产组(22例),比较D-D二聚体(D-D)、红细胞叶酸、血浆叶酸及纤维蛋白原(Fbg)、凝血酶原时间(PT)、凝血酶时间(TT)及活化部分凝血活酶时间(APTT)的差异,分析其诊断价值。结果:流产组RSA次数≥4次占比(68.2%)高于未流产组(36.7%),D-D(429.23±52.78μg/L)高于未流产组(392.51±51.12μg/L),红细胞叶酸(428.71±120.52 ng/ml)及血浆叶酸(7.32±3.28 ng/ml)水平低于未流产组(492.68±122.41ng/ml、9.34±3.87ng/ml)(P<0.05);两组Fbg、PT、TT及APTT水平无差异(P>0.05);logistic回归分析,D-D、红细胞叶酸及血浆叶酸是RSA的影响因素;血浆叶酸诊断RSA的曲线下面积(AUC)最高为0.718,敏感度45.5%,特异性为90.0%;3项联合诊断RSA的AUC为0.626,敏感度31.8%,特异性93.3%。结论:孕期D-D二聚体、叶酸和凝血功能指标联合检测对RSA再孕时自然流产的风险预测有一定价值,其特异性较高,但存在漏诊风险。Objective:To study the diagnostic value of D dimer(D-D),folic acid,and coagulation function indexes for:recurrent spontaneous abortion(RSA)during pregnancy.Methods:A total of 52 pregnant women with RSA during the first trimester of pregnancy were selected in the study group between January 2020 and January 2022.According to the occurrence of abortion of the women within 14 gestational weeks,these women were divided into group A(30 cases without spontaneous abortion)and group B(22 cases with spontaneous abortion).The levels of D-D,folic acid in red.blood cells,plasma folic acid,and fibrinogen(Fbg),and the values of prothrombin time(PT),thrombin time(TT),and activated partial thromboplastin time(APTT)of the women were compared between the two groups,and the diagnostic value of which for recurrent spontaneous abortion was analyzed.Results:The proportion of the number of RSA≥4 times(68.2%)and the D-D level(429.23±52.78 mu g/L)of the women in group B were significantly higher than those(36.7% and 392.51±51.12 mu g/L)of the women in group A.The levels of folic acid in red blood cells(428.71±120.52 ng/ml)and plasma folic acid(7.32±3.28 ng/ml)of the women in group B were significantly lower than those(492.68±122.41ng/ml and 9.34±3.87ng/ml)of the women in group A(P<0.05).There were no significant differences in the values of Fbg,PT,TT,and APTT of the women between the two groups(P>0.05).Logistic regression analysis showed that the levels of D-D and folic acid in red blood cells and in plasma were the influence factors of RSA.The maximum area under curve(AUC),the sensitivity,and the specificity of levels of folic acid in red blood cells and plasma for diagnosing RSA were 0.718,45.5%,and 90.0%,respectively.The AUC,the sensitivity,and the specificity of the combined of the levels of D-D and folic acid,and the coagulation function for diagnosing RSA were 0.626,31.8%,and 93.3%,respectively.Conclusion:The combined detections of D-D,folic acid,and coagulation function of the pregnant women with RSA for diagnosing their R

关 键 词：复发性流产 再孕流产 D-D二聚体 叶酸 凝血指标 诊断价值 影响因素 

分 类 号：R714.21[医药卫生—妇产科学]