妊娠期高血压疾病单胎妊娠并发胎盘早剥的风险预测  

Risk prediction of placental abruption in singleton pregnancy with hypertensive disorders of pregnancy

作　　者：汪文昕 汪若兰 方媛媛 沈清媚 汪朦 杨宽英 范懿隽[1] WANG Wenxin;WANG Ruolan;FANG Yuanyuan;SHEN Qingmei;WANG Meng;YANG Kuanying;FAN Yijun(Department of Obstetrics and Gynecology,the Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230601,China)

机构地区：[1]安徽医科大学第二附属医院妇产科,安徽合肥230601

出　　处：《中华全科医学》2024年第8期1367-1370,共4页Chinese Journal of General Practice

基　　金：安徽省自然科学基金项目(2208085MH205);安徽医科大学第二附属医院临床研究培育计划(2021LCZD05)。

摘　　要：目的探讨妊娠期高血压疾病(HDP)单胎妊娠患者并发胎盘早剥的危险因素以预测发生风险。方法回顾性分析2014年1月—2022年1月在安徽医科大学第二附属医院妇产科住院诊治且符合纳排标准的1595例HDP患者临床资料,根据有无并发胎盘早剥分为研究组(发生胎盘早剥,34例)和对照组(未发生胎盘早剥,1561例)。记录患者人口学特点、临床特点和实验室检测结果,采用单因素和多因素logistic回归模型分析HDP患者并发胎盘早剥的危险因素,并建立ROC曲线评价预测效能。结果1595例HDP患者中,34例(2.13%)发生胎盘早剥。研究组血D-二聚体(P=0.005)、血肌酐(P=0.044)、血尿素氮(P=0.043)、谷草转氨酶(P=0.014)水平较高,血小板计数(P=0.012)、纤维蛋白原(P=0.011)水平较低,且发病与HDP分型相关。血D-二聚体水平(P=0.009)、纤维蛋白原水平(P<0.001)及HDP分型[重度子痫前期(P=0.033)、子痫(P=0.001)]是HDP患者并发胎盘早剥的影响因素。其中,纤维蛋白原预测胎盘早剥的灵敏度最高(55.9%),D-二聚体特异度最高(84.2%),D-二聚体与纤维蛋白原联合预测灵敏度(61.8%)高于所有单项指标。HDP分型的AUC最低[0.617(95%CI:0.515~0.720)],D-二聚体+纤维蛋白原+HDP分型联合预测的AUC最高[0.735(95%CI:0.639~0.831)]。结论不同HDP表型对单胎妊娠患者并发胎盘早剥有显著影响,当纤维蛋白原降低、D-二聚体升高时,应高度警惕HDP单胎妊娠患者并发胎盘早剥。Objective To investigate the risk factors for placental abruption in singleton pregnancy with hypertensive disorders of pregnancy(HDP).Methods The clinical data of 1595 HDP patients who met the inclusion criteria and were hospitalized in the Department of Obstetrics and Gynecology in the Second Affiliated Hospital of Anhui Medical University,from January 2014 to January 2022,were retrospectively analyzed.According to the occurrence of placental abruption,they were divided into study group(with placental abruption,34 cases)and control group(without placental abruption,1561 cases).Demographic characteristics,clinical characteristics and laboratory test results were recorded.Univariate and multivariate logistic regression models were used to analyze the risk factors of HDP patients with placental abruption,and an ROC curve was constructed to evaluate the predictive efficacy.Results Among 1595 HDP patients enrolled in this study,34 were diagnosed with placental abruption(2.13%).Compared with the control group,the study group had higher levels of D-dimer(P=0.005),serum creatinine(P=0.044),blood urea nitrogen(P=0.043)and aspartate aminotransferase(P=0.014),and lower levels of platelet count(P=0.012)and fibrinogen(P=0.011).Serum D-dimer level(P=0.009),fibrinogen level(P<0.001)and HDP types[severe preeclampsia(P=0.033),eclampsia(P=0.001)]were the influencing factors of placental abruption in HDP patients.Among them,fibrinogen had the highest predictive sensitivity(55.9%)and D-dimer had the highest specificity(84.2%).The sensitivity of the combination of D-dimer and fibrinogen was higher than that of the individual risk factors(61.8%).The AUC of HDP types was the lowest[0.617(95%CI:0.515-0.720)],and the AUC of D-dimer+fibrinogen+HDP types was the highest[0.735(95%CI:0.639-0.831)].Conclusion Different types of HDP have a significant impact on placental abruption in singleton pregnancy.If fibrinogen is decreased and D-dimer is increased,placental abruption should be highly suspected in singleton pregnancy with HDP.

关 键 词：妊娠期高血压 胎盘早剥 危险因素 D-二聚体 纤维蛋白原 

分 类 号：R714.246[医药卫生—妇产科学] R714.43[医药卫生—临床医学]