D-二聚体及白细胞对孕妇Pre-DIC的预测价值

Predictive value of D-dimer and leukocyte for the disseminated inravascular coagulation in pregnant women

目的:观察D-二聚体(D-D)与白细胞(WBC)对孕妇弥散性血管内凝血(DIC)前状态(Pre-DIC)的预测价值。方法:选择57例妊娠并发生DIC的患者为妊娠DIC组,另选健康体检妇女30例为正常对照组,正常妊娠妇女30例,为正常妊娠组。采用美国ACLAd-vance全自动血细胞凝集仪检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及凝血酶时间(TT)。D-D检测采用免疫比浊法;血浆鱼精蛋白副凝固试验(3P)、血小板计数(PLT)、白细胞(WBC)按常规方法。纤维蛋白原(Fib)、AT-Ⅲ采用酶联免疫吸附法(ELISA)测定。分析三组PT,TT,APTT,Fib,PLT,AT-Ⅲ,D-D,WBC,3P阳性率的差异,同期观察妊娠DIC组中不同诱因:胎盘早剥、羊水栓塞、死胎引产、先兆子痫、子宫破裂及难治性宫缩乏力患者PT,TT,APTT,Fib,PLT,AT-Ⅲ,D-D,WBC检测的差异,并通过图示分析找到D-D,WBC对Pre-DIC的预测范围值。结果:三组PT,TT,APTT,PLT,AT-Ⅲ,D-D,WBC比较,差异有统计学意义(P<0.01),PT,TT,APTT,D-D,WBC组间两两比较差异有统计学意义(P<0.05,P<0.01)。妊娠DIC组各种诱因的凝血因子PT,TT,APTT,Fib,PLT,AT-Ⅲ比较,差异均有统计学意义(P<0.01),各种诱因的PLT,AT-Ⅲ两两比较,PLT除B-D、B-C无差异外,AT-Ⅲ除C-D无差异外,其余均有统计学意义(P<0.01,P<0.05)。孕妇PreDIC的预测指标D-D>2 mg/L且<2.4 mg/L,WBC≥14×109/L。结论:妊娠妇女血D-D含量、WBC升高到一定值,结合起来拟可作为妊娠Pre-DIC的判断指标。

Objective： To observe predictive value of D-dimer and leukocyte for the disseminated inravascular coagulation（ pre-DIC） in pregnant women. Methods： Fifty-seven pregnancy patients with DIC（ observation group,30 cases of normal control group（ healthy women）,30 cases of normal pregnancy control group（ normal pregnant women） were selected. Prothrombin time（ PT）,activated partial thromboplastin enzyme time（ APTT） and thrombin time（ TT） were detected with with the U.S. ACLAd-vance automatic coagulometer. D-dimer（ DD） were measured. by immune turbidimetry; plasma protamine sulfate deputy coagulation tests（ 3P）,and platelet count（ PLT）,white blood cell（ WBC） was examined by conventional methods. Fibrinogen（ Fib）,AT-Ⅲ were measured by enzyme-linked immunosorbnent assay（ ELISA）. The differences of PT,TT and APTT,Fib,PLT,AT-Ⅲ,and DD,the WBC,positive rate of 3P were analyzed in the three groups,PT,TT and APTT,Fib,PLT,AT-Ⅲ,and DD,the WBC of placental abruption,amniotic fluid embolism,induction of labor stillbirth,pre-eclampsia,uterine rupture and refractory uterine atony in the pregnancy DIC group were observed different over the same period： Forecast range values of the DD and the WBC for the Pre-DIC was detected by graphic analysis. Results： PT,TT,APTT and the PLT,AT-Ⅲ,and DD,the WBC in three groups were significant difference（ P〈0. 01）,PT,TT and APTT,and DD,the WBC were significantly different compared between two groups（ P〈0. 05,P〈0. 01）. PT,TT and APTT,Fib,the PLT,the AT-Ⅲ in predisposing factors of pregnancy DIC group were statistically significant（ P〈0. 01）,a variety of incentives PLT,AT-Ⅲ in pairwise comparison were statistically significant in addition to BD,BC of PLT,the CD in the AT-Ⅲ（ P〈0. 05,P〈0. 01）.Graphic analysis shows that the pre-DIC predictors in pregnant women,were D-dimer≥2 mg / Land 〈2. 4 mg / L,the WBC ≥ 14 × 10^9/L. Conclusion： Blood D. Dimer and the WBC in pregnant women can be as judgment indicators of pregnancy Pre-DIC when they increased to a certain value.