产科弥散性血管内凝血患者凝血指标动态观察及意义

Dynamic observation and significance of coagulation parameters in women with obstetric disseminated intravascular coagulation

目的探讨凝血实验室指标在产科弥散性血管内凝血(DIC)中的动态变化及临床意义。方法检测26例在分娩前后出现DIC的产妇,于确诊DIC时,对症治疗后2 h、24 h、7 d常规凝血试验及凝血因子Ⅷ促凝活性(Ⅷ∶C)、血浆D-二聚体(DD)、血管性血友病因子(VWF)、抗凝血酶活性(AT∶A)、纤溶酶原活性(PLG∶A)、凝血酶-抗凝血酶复合物(TAT)和组织因子(TF)含量,同时检测31名正常产妇作为对照。结果发生DIC的产妇治疗前与对照组比较,常规凝血试验均发生明显变化,治疗后各参数逐渐恢复正常,至第7天大部分参数在正常参考范围内;治疗前血浆DD、Ⅷ∶C、VWF、TF、TAT均明显高于对照组(P<0.01),AT∶A、PLG∶A均明显低于对照组(P<0.01),治疗后各参数均有不同程度的改善,第7天时,除DD、VWF、TF、PLG∶A有轻度异常外,其余参数基本正常。结论常规凝血指标及凝血分子标志物不仅可用于诊断产妇DIC,也是产妇DIC治疗过程中很好的监测指标。

Objective To investigate the dynamic change and significance of coagulation parameters in obstetric disseminated intravascular coagulation （DIC）. Methods Routine coagulation tests and coagulation makers were determined in 26 women with DIC before or after delivery and 31 women with normal delivery as control. These tests were done on the diagnosing moment of DIC and at 2 hours,24 hours and 7 days after symptomatic therapy. Coagulation makers including coagulation factor Ⅷ activity （Ⅷ： C）, D-Dimer （DD）, yon Willebrand factor （VWF）, antithrombin activity （AT： A） ,plasminogen （ PLG： A）, thrombin-antithrombin complex （TAT） and tissue factor （TF）. Results Compared with control group, coagulation parameters were obviously changed in women with obstetric DIC before symptomatic therapy, and gradually recovered after the treatment. Most part of parameters were normal at 7 days after the treatment. Compared with control group, DD, Ⅷ： C, VWF, TF and TAT were obviously increased （P 〈 0.01 ） ,but AT： A and PLG ;A were obviously decreased （ P 〈 0.01 ） in women with obstetric DIC before symptomatic therapy. These parameters were improved in different degree after the treatment, although DD, VWF, TFand PLG： A were slightly abnormal, others were basically normal at 7 days after the treatment. Conclusions Routine coagulation parameters and coagulation makers are useful indexes not only for the diagnosis of DIC, but also to monitor therapeutic effect of DIC in obstetrics.