孕期及产褥期血D-二聚体水平变化情况及与静脉血栓栓塞症发生关系
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摘要
目的:探讨孕期及产褥期血D-二聚体水平变化及与静脉血栓栓塞症发生关系。方法:收集本院常规围产期保健及分娩的孕产妇3500例(观察组),同期常规体检且年龄、体质量指数与观察组匹配的健康女性50例作为对照组。分别在观察组早孕期、中孕期、晚孕期、产后24h及72h检测血D-二聚体水平。比较对照组与观察组不同时期D-二聚体水平,分析分娩方式、静脉血栓栓塞症D-二聚体水平,使用ROC曲线观察D-二聚体水平对血栓栓塞症预测值。结果:观察组孕期及产褥期血D-二聚体水平均高于对照组,产后24h高于其他各期,早孕期水平其次,中孕期血水平最低(均P<0.05)。产后24h、72h剖宫产产妇血D-二聚体水平高于经阴道分娩产妇(P<0.05)。产后发生静脉血栓栓塞症10例,其晚孕期、产后24h、产后72h血D-二聚体水平高于无栓塞产妇(P<0.05)。产后24h D-二聚体水平(1.97mg/L)预测血栓栓塞症的价值最高,此时预测灵敏度为69.4%,特异度为76.8%,曲线下面积为0.74。结论:孕期及产褥期血D-二聚体水平呈现升高-下降-升高变化,且均高于未孕女性。分娩方式影响D-二聚体水平,产后24h D-二聚体水平对产后静脉血栓栓塞症发生具有一定预测价值。
Objective: To investigate the changes of blood D-dimer level of women during pregnancy and puerperium, and to study the relationship between the change of D-dimer level and the venous thromboembolism occurrence. Methods: 3500 pregnant women were enrolled in the observation group, 50 healthy non-pregnant women were selected into the control group. Blood D-dimer level of women in the observation group were measured during the first, the second and the third trimester pregnancy, and at postpartum 24 h and 72 h. The levels of D-dimer of women were compared between the two groups. In the observation group, the delivery model and D-dimer levels of women with venous thromboembolism were analyzed. The ROC curve was used to analyze the predictive value of D-dimer level of women on thromboembolism. Results: The blood D-dimer level of women in the observation group was significant higher than that of women in the control group. In the observation group, the level of blood D-dimer of women at 24 h after delivery was the highest, that during the first trimester pregnancy was the second highest, but that during the second trimester pregnancy was lowest(P<0.05). The blood D-dimer level of women with cesarean section at puerperium 24 h and 72 h was significant higher than that of women after transvaginal delivery(P<0.05). In the observation group, there were 15 women with postpartum venous thromboembolism, which blood D-dimer level during the third trimester pregnancy and at postpartum 24 h and 72 h was significant higher than that of other women(P<0.05). The D-dimer level(1.97 mg/L) at postpartum 24 h had the highest value for predicting venous thromboembolism occurrence, which sensitivity was 69.4%, the specificity was 76.8%, and the area under the curve was 0.74. Conclusion: The level of blood D-dimer of women has showed a pattern from increasing to decreasing,then to increasing during pregnancy and puerperium,which was higher than that of non-pregnant women.The delivery model of women affects their D-dimer levels,and the level of D-dimer at postpartum 24 hhas some value for predicting venous thromboembolism occurrence.
Objective: To investigate the changes of blood D-dimer level of women during pregnancy and puerperium, and to study the relationship between the change of D-dimer level and the venous thromboembolism occurrence. Methods: 3500 pregnant women were enrolled in the observation group, 50 healthy non-pregnant women were selected into the control group. Blood D-dimer level of women in the observation group were measured during the first, the second and the third trimester pregnancy, and at postpartum 24 h and 72 h. The levels of D-dimer of women were compared between the two groups. In the observation group, the delivery model and D-dimer levels of women with venous thromboembolism were analyzed. The ROC curve was used to analyze the predictive value of D-dimer level of women on thromboembolism. Results: The blood D-dimer level of women in the observation group was significant higher than that of women in the control group. In the observation group, the level of blood D-dimer of women at 24 h after delivery was the highest, that during the first trimester pregnancy was the second highest, but that during the second trimester pregnancy was lowest(P<0.05). The blood D-dimer level of women with cesarean section at puerperium 24 h and 72 h was significant higher than that of women after transvaginal delivery(P<0.05). In the observation group, there were 15 women with postpartum venous thromboembolism, which blood D-dimer level during the third trimester pregnancy and at postpartum 24 h and 72 h was significant higher than that of other women(P<0.05). The D-dimer level(1.97 mg/L) at postpartum 24 h had the highest value for predicting venous thromboembolism occurrence, which sensitivity was 69.4%, the specificity was 76.8%, and the area under the curve was 0.74. Conclusion: The level of blood D-dimer of women has showed a pattern from increasing to decreasing,then to increasing during pregnancy and puerperium,which was higher than that of non-pregnant women.The delivery model of women affects their D-dimer levels,and the level of D-dimer at postpartum 24 hhas some value for predicting venous thromboembolism occurrence.
引文
[1] 李晓丹,张锋,吴林斌,等.妊娠期高血压疾病凝血和纤溶实验室指标变化的临床意义[J].中华全科医学,2014,12(9):1424-1426.
[2] 王莉敏.妊娠晚期孕妇凝血四项、FDP、D-二聚体的变化及临床意义[J].中华全科医学,2013,11(12):1951-1952.
[3] 陈奕,朱燕.妊娠期及产褥期静脉血栓栓塞症的诊断与治疗[J].中华妇产科杂志,2018,53(9):635-639.
[4] Olson J D.D-dimer:An Overview of Hemostasis and Fibrinolysis,Assays,and Clinical Applications[J].Adv Clin Chem,2015,69:1-46.
[5] Gutierrez G I,Perez C P,Martinez U J,et al.D-dimer during pregnancy:establishing trimester-specific reference intervals[J].Scand J Clin Lab Invest,2018,78(6):439-442.
[6] Hedengran K K,Andersen M R,Stender S,et al.Large D-Dimer Fluctuation in Normal Pregnancy:A Longitudinal Cohort Study of 4,117 Samples from 714 Healthy Danish Women[J].Obstet Gynecol Int,2016,2016:3561675.
[7] Kovac MK,Lalic-Cosic SZ,Dmitrovic JM,et al.Thrombingeneration,D-dimer and protein S in uncomplicated pregnancy[J].Clin Chem Lab Med,2015,53(12):1975-1979.
[8] 徐冬,蔡淑萍,徐静薇,等.孕期及产褥早期妇女血浆D-二聚体水平的变化[J].中华妇产科杂志,2016,51(9):666-671.
[9] Epiney M,Boehlen F,Boulvain M,et al.D-dimer levelsduring delivery and the postpartum[J].J Thromb Haemost,2005,3(2):268-271.
[10] Villani M,Ageno W,Grandone E,et al.The prevention and treatment of venous thromboembolism in pregnancy[J].Expert Rev Cardiovasc Ther,2017,15(5):397-402.
[11] Chan W S.Diagnosis of venous thromboembolism in pregnancy[J].Thromb Res,2018,163:221-228.
[12] 胡晓雨,禹虹,边旭明.妊娠期及产褥期静脉血栓栓塞16例临床分析[J].中华围产医学杂志,2011,14(12):724-728.
[2] 王莉敏.妊娠晚期孕妇凝血四项、FDP、D-二聚体的变化及临床意义[J].中华全科医学,2013,11(12):1951-1952.
[3] 陈奕,朱燕.妊娠期及产褥期静脉血栓栓塞症的诊断与治疗[J].中华妇产科杂志,2018,53(9):635-639.
[4] Olson J D.D-dimer:An Overview of Hemostasis and Fibrinolysis,Assays,and Clinical Applications[J].Adv Clin Chem,2015,69:1-46.
[5] Gutierrez G I,Perez C P,Martinez U J,et al.D-dimer during pregnancy:establishing trimester-specific reference intervals[J].Scand J Clin Lab Invest,2018,78(6):439-442.
[6] Hedengran K K,Andersen M R,Stender S,et al.Large D-Dimer Fluctuation in Normal Pregnancy:A Longitudinal Cohort Study of 4,117 Samples from 714 Healthy Danish Women[J].Obstet Gynecol Int,2016,2016:3561675.
[7] Kovac MK,Lalic-Cosic SZ,Dmitrovic JM,et al.Thrombingeneration,D-dimer and protein S in uncomplicated pregnancy[J].Clin Chem Lab Med,2015,53(12):1975-1979.
[8] 徐冬,蔡淑萍,徐静薇,等.孕期及产褥早期妇女血浆D-二聚体水平的变化[J].中华妇产科杂志,2016,51(9):666-671.
[9] Epiney M,Boehlen F,Boulvain M,et al.D-dimer levelsduring delivery and the postpartum[J].J Thromb Haemost,2005,3(2):268-271.
[10] Villani M,Ageno W,Grandone E,et al.The prevention and treatment of venous thromboembolism in pregnancy[J].Expert Rev Cardiovasc Ther,2017,15(5):397-402.
[11] Chan W S.Diagnosis of venous thromboembolism in pregnancy[J].Thromb Res,2018,163:221-228.
[12] 胡晓雨,禹虹,边旭明.妊娠期及产褥期静脉血栓栓塞16例临床分析[J].中华围产医学杂志,2011,14(12):724-728.