正常妊娠妇女及妊娠期高血压疾病患者血浆D-二聚体改变的前瞻性研究

Perspective study on maternal D-dimer levels in healthy pregnant females and those pregnant females with subsequent hypertensive disorder in first,second and third trimester

目的:研究正常妊娠以及妊娠期高血压疾病母体血浆D-二聚体(D-dimer,D-D)水平随妊娠发展的变化趋势。方法:应用前瞻性研究方法,对180例妊娠前血压正常的孕妇,检测母体血浆D-D在妊娠10～14、20～24、30～34周的水平,观察D-D在孕妇孕期变化情况并随访妊娠结局;选取50例血压正常未孕妇女作为对照。结果:①180例进入本研究妊娠妇女,12例发生妊娠期高血压、10例子痫前期(4例重度、6例轻度)、158例孕妇妊娠结局正常;②正常妊娠后,母体血浆D-D浓度在妊娠10～14周高于正常未孕妇女,差异有统计学意义(P<0.01),妊娠10～14、20～24、30～34周、随孕周增加,母体血浆D-D浓度逐渐上升,差异均有统计学意义(均P<0.01);③子痫前期、妊娠期高血压、正常妊娠妇女母体血浆D-D浓度在妊娠10～14、20～24、30～34周,同期比较差异均无统计学意义(均P>0.05)。结论:正常妊娠妇女与妊娠期高血压疾病患者母体血浆D-D随着妊娠进展浓度逐渐增加,但在本研究中2者间差异无统计学意义,故以其作为疾病早期预测指标宜谨慎。

Objective：To prospectively study the changes of maternal plasma D-dimer （D-D） levels in healthy pregnant females and those pregnant females with hypertensive complication. Method：One hundred and eighty pregnant women with previously normal blood pressure were prospectively included in the study. Maternal peripheral venous blood samples were obtained at 10-14, 20-24 and 30-34 gestational weeks. Plasma levels of D-D were measured by enzyme-linked immunoassay technique. Fifty non-pregnant healthy women were chosen as control （non-pregnant group）. The outcomes of pregnancies were followed up. Result：（1）Among 180 women with previously normal blood pressure, 12 developed gestational hypertension （gestational hypertension group）, 6 developed severe preeclampsia and 4 developed mild preeclampsia （preeclampsia group）, 158 remained normal till the end of pregnancy （normal pregnancy group）. （2） In healthy normal pregnant women, the levels of D-D at 10 -14 gestational weeks were statistically significantly higher than those in healthy non-pregnant women （ P 〈0. 01）. With the development of pregnancy, the levels of maternal D-D were gradually upgraded at 10-14, 20-24, 30- 34 gestational weeks, and all of them had statistical significance （ P〈0.01）. （3）At the same stages of 10-14, 20-24, 30-34 gestational weeks, the maternal levels of D-D had no difference among preeclampsia, gestationalhy- pertension and healthy normal pregnancy group （ P〉0.05, respectively）. Conclusion：During pregnancy, the levels of maternal D-D in normal group and hypertensive disorder complication group were higher with the advance of pregnancy, but there is no difference between these two groups. It should be careful to explain the results of D-D.