妊娠不同时期孕妇血浆凝血四项、FDP、D-二聚体和AT-Ⅲ的变化及临床意义

Changes of plasma coagulation profiles,FDP,D-dimer and AT-Ⅲ in pregnant women at different stages of pregnancy and their clinical significance

目的探讨妊娠不同时期孕妇血浆凝血四项、纤维蛋白原降解产物(FDP)、D-二聚体及抗凝血酶(AT)-Ⅲ的变化及临床意义。方法选取2017年1月至2018年2月收治的妊娠期妇女358例为研究对象,包括孕早期78例(妊娠10～15周)、孕中期82例(妊娠20～25周)、孕晚期94例(妊娠30～35周)及临产期104例(妊娠37～42周)。采集空腹静脉血5 ml,检测D-二聚体(D-D)、血浆凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、FDP和AT-Ⅲ。结果除TT外,不同妊娠时期孕妇PT、APTT和FIB以及FDP、DD、AT-Ⅲ比较差异均有统计学意义(P <0. 05,P <0. 01),呈现随着孕周的延长,PT、APTT逐渐降低,FIB、FDP、D-D和AT-Ⅲ水平逐渐上升(P <0. 05,P <0. 01)。结论随着孕周的延长,孕妇血液体内凝血因子水平明显升高,为减少孕妇产后出血提供了有利条件,但也增加了血栓发生的风险。因此,动态监测妊娠期孕妇凝血四项、FDP、D-D及AT-Ⅲ的变化对于预防产后高凝所致的并发症具有重要意义。

Objective To investigate the changes of plasma coagulation profiles,fibrinogen degradation products( FDP),D-dimer and antithrombin( AT)-Ⅲ in pregnant women at different stages of pregnancy and their clinical significance.Methods A total of 358 pregnant women admitted from January 2017 to February 2018 were selected as study subjects,including 78 cases in early pregnancy( 10-15 weeks of pregnancy),82 cases in second trimester( 20-25 weeks of pregnancy),94 cases in late pregnancy( 30-35 weeks of pregnancy) and 104 cases in parturient period( 37-42 weeks of pregnancy). After 5 ml of fasting venous blood was collected from pregnant woman,the levels of D-dimer( D-D),plasma prothrombin time( PT),thrombin time( TT),activated partial prothrombin time( APTT),fibrinogen( FIB),fibrin degradation products( FDP) and antithrombin Ⅲ( AT-Ⅲ) were detected. Results Except TT,there were significant differences in the levels of PT,APTT,FIB,FDP,D-D and AT-Ⅲ of pregnant women in different gestational periods( P <0. 05,P < 0. 01). With the prolongation of gestational age,PT and APTT decreased gradually,while FIB,FDP,D-D and AT-Ⅲ increased gradually( P < 0. 05,P < 0. 01). Conclusions With the prolongation of gestational age,the levels of blood coagulation factors in pregnant women increase obviously,which provides favorable conditions for reducing postpartum hemorrhage of pregnant women,but also increases the risk of thrombosis. Therefore,dynamic monitoring of coagulation profiles,FDP,D-D and AT-Ⅲ during pregnancy has great significance in preventing complications caused by postpartum hypercoagulability.