血浆D二聚体水平在预测子前期发病中的价值

Value of plasma D-dimer levels in predicting preeclampsia

关键词:  子前期  D-二聚体  妊娠结局

Key words:  preeclampsia  D-dimer  pregnancy outcomes

摘要:

目的探讨血浆D二聚体在预测子前期发病中的的价值。方法 收集2013年6月至2014年12月间建卡产检并分娩的孕产妇资料共计13285例,所有孕妇均定期产检,随访至产后3个月并收集相关资料。其中有10623例为无妊娠合并症的正常孕产妇,作为正常对照组；有577例诊断为妊娠期高血压,作为妊娠期高血压组。291例为子前期患者,作为子前期组对象,其中214例为轻度子前期,77例为重度子前期。所有研究对象在孕32周~34周间进行血浆D-二聚体的检测,分析D-二聚体在预测子前期发病中的作用及其与不良妊娠结局的关系。结果经T检验表明,子前期组的D-二聚体水平高于妊娠期高血压组,而妊娠期高血压组高于对照组(P＜0.01)。但在轻、重度子前期组间D-二聚体的表达差异无统计学意义(P=0.728)。通过Pearson双变量相关法研究D-二聚体水平与各妊娠结局间的关系,结果表明D-二聚体水平越高,产后出血量越大,早产和难产率也越高,而新生儿Apgar评分和出生体质量均越低。应用Logistics回归方程证实了孕晚期D-二聚体水平的升高可预测子前期的发病。并应用ROC曲线计算得出D-二聚体的预测界值为0.995mg/L时,其预测敏感度为95.8%,相对危险度为7.35。结论D-二聚体可作为预测子前期发病的实验室指标,且其与各种不良妊娠结局均有相关性,D-二聚体预测子前期发病的界值为0.995mg/L,其预测敏感度为95.8%,相对危险度为7.35。

Abstract:

Objective To evaluate the detection of plasma D-dimer in predicting preeclampsia. MethodsTotal of 13285 pregnant women undergoing regular antenatal examination and delivery between June 2013 and December 2014 were enrolled in the study. All pregnant women were followed up for 3 months postpartumly and the related information was collected. There were 10623 cases without pregnancy complications(control group), 577 cases with pregnancy induced hypertension(gestational hypertension group) and 291 cases with preeclampsia, including 214 mild cases and 77 severe cases. Plasma D-dimer levels were measured in all subjects, and the association of D-dimer with preeclampsia and adverse pregnancy outcomes was analyzed. Results Plasma D-dimer levels in preeclampsia group were higher than those in control group and gestational hypertension group(P＜0.01)； however, there was no significant difference(P=0.728) between the mild and severe preeclampsia group. Pearson bivariate correlation showed that D-dimer levels were positively correlated with incidence of postpartum hemorrhage, premature birth and difficult delivery, and negatively correlated with Apgar score and birth weight. Logistic regression equation showed that the increase of D-dimer level was associated with the onset of preeclampsia. The ROC curves showed the predicted cut-off value of D-dimer was 0.995mg/L, the sensitivity was 95.8% and the relative risk was 7.35. ConclusionD-dimer can be used as a laboratory index to predict the onset of preeclampsia, and it is correlated with adverse pregnant outcomes.