D-二聚体/血小板计数比值预测凶险性前置胎盘患者产后出血效能

Predictive efficacy of D-dimer/platelet ratio of patients with pernicious placenta previa for their postpartum hemorrhage

目的:探讨D-二聚体/血小板计数比值(DPR)对凶险性前置胎盘(PPP)患者产后出血的预测效能。方法:收集2019-2023年本院收治的102例PPP患者临床资料,检测D-二聚体和血小板计数并计算DPR,根据PPP患者是否并发产后出血(阴道分娩产后出血量≥500ml、剖宫产术后24h内出血量≥1000ml)分为出血组(n=27)与未出血组(n=75)。采用受试者工作特性(ROC)曲线评估DPR对PPP患者产后出血的预测效能,采用二分类logistic逐步回归分析PPP患者产后出血影响因素。结果:出血组D-二聚体(0.94±0.41 mg/L)、DPR(0.67±0.24)均高于未出血组(0.36±0.25 mg/L、0.29±0.12),血小板计数(243.96±32.51)×10^(9)/L低于未出血组(301.02±40.39)×10^(9)/L(均P<0.05)。DPR预测PPP患者产后出血的最佳截点值为0.46,曲线下面积0.914。logistic逐步回归分析,患者年龄≥35岁(OR=1.260)、胎盘植入类型为穿透型(OR=3.284)、DPR≥0.56(OR=5.094)是PPP患者产后出血的危险因素(均P<0.05)。结论:发生产后出血的PPP患者DPR呈高表达,且DPR预测PPP患者产后出血有一定临床效能。

Objective:To investigate the predictive efficacy of D-dimer/platelet ratio(DPR)of patients with pernicious placenta previa(PPP)for their postpartum hemorrhage.Methods:The clinical data of 102 patients with PPP admitted to the hospital from January 2021 to January 2023 were collected.The D-dimer level and the platelet counts of the patients were detected,and the DPR was calculated.According to whether the patients with PPP complicated with postpartum hemorrhage(postpartum hemorrhage≥500 ml after vaginal delivery,or postpartum hemorrhage≥1000 ml within 24 hours after cesarean section),these patients were divided into group A(27 patients with postpartum hemorrhage)and group B(75 patients without postpartum hemorrhage).The predictive efficacy of DPR of the patients with PPP for their postpartum hemorrhage was evaluated by receiver operator characteristic(ROC)curve.The influencing factors of the postpartum hemorrhage of the patients with PPP were explored by binary logistic stepwise regression analysis.Results:The D-dimer level(0.94±0.41 mg/L),the DPR(0.67±0.24)of the patients in group A were significantly higher than those(0.36±0.25 mg/L and 0.29±0.12)of the patients in group B.The platelet count(243.96±32.51×10^(9)/L)of the patients in group A wats significantly lower than that(301.02±40.3×10^(9)/L)of the patients in group B(all P<0.05).The optimal cut-off value and the area under the curve of the DPR of the patients with PPP for predicting their postpartum hemorrhage were 0.46 and 0.914.Logistic stepwise regression analysis showed that the age≥35 years old(OR=1.260),the penetrate placenta percreta(OR=3.284),the DPR≥0.56(OR=5.094)of the patients with PPP were all the risk factors of their postpartum hemorrhage(all P<0.05).Conclusion:The DPR of the patients with PPP and postpartum hemorrhage is highly expressed,and the DPR of the patients with PPP has certain clinical efficacy for predicting their postpartum hemorrhage postpartum.