D-二聚体测定对妊娠子痫前期孕产妇产后出血的预测意义

Predictive significance of D-dimer determination in postpartum hemorrhage of pregnant women with preeclampsia

目的探讨D-二聚体检测对妊娠子痫前期孕产妇产后出血的预测意义。方法选取2012年10月-2014年9月本院产科收治的144例妊娠期子痫前期的孕产妇,对其分娩前24 h内D-二聚体进行测定,并准确计量其分娩后24 h的总出血量,依出血量将其分为产后出血组与对照组。组间比较采用Wilcoxon秩和检验,分析其分娩前24 h内D-二聚体测定值与分娩后24 h内的出血量的相关性,以ROC曲线分析其对妊娠期子痫前期孕产妇产后出血的预测截断值。结果产后出血31例,产后出血率为21.53%（31/144）。与对照组比较,产后出血组D-二聚体的含量为（3 200.39±2 209.68）mg/ml,显著高于对照组D-二聚体的含量,即（1 658.58±790.32）mg/ml,差异有统计学意义（z=4.87,P〈0.01）。ROC曲线下方面积为0.786 2,95%CI为0.698 6～0.873 8,对应的最佳切割点为D-二聚体取值为2 007.76 mg/ml时,灵敏度为70.97%,特异度为70.80%,Youden指数为41.77%,正确率为70.83%。结论 D-二聚体检测对妊娠子痫前期孕妇产后出血的预测有意义,以2 007.76 mg/ml作为产后出血的预测截断值较理想。

Objective To investigate the predictive significance of D- dimer determination in postpartum hemorrhage of pregnant women with preeclampsia. Methods 144 cases of pregnant women with preeclampsia were selected in this study,all of whom were admitted in Ruian maternal and child health hospital from October 2012 to September 2014. The patients were determined for D- dimer within 24 h before delivery,and their total blood loss within 24 h after delivery was accurately measured.Then the patients were divided into postpartum hemorrhage group and the control group based on the blood loss. Wilcoxon rank- sum test was used to compare between groups. The correlation between D- dimer detective value within 24 h before delivery and blood loss within 24 h after delivery was analyzed. ROC curve was used to analyze the predicted cut- off value of postpartum hemorrhage in pregnant women with preeclampsia. Results 31 cases developed postpartum hemorrhage,with the postpartum hemorrhage rate of 21. 53%（ 31 /144）. The content of D- dimer was significantly higher in postpartum hemorrhage group（ 3 200. 39 ± 2 209. 68） mg / ml than that in control group（ 1 658. 58 ± 790. 32） mg / ml with statistical significance（ z =4. 87,P〈0. 01）. Area under the ROC curve was 0. 7 862,95% CI was 0. 698 6- 0. 873 8. The corresponding optimal cut point for D- dimer was 2 007. 76 mg / ml,where the sensitivity was 70. 97%,the specificity was 70. 80%,Youden index was41. 77%,and accurate rate was 70. 83%. Conclusion The prediction of the D- dimer was significant for the prediction of postpartum hemorrhage in the pregnant women with preeclampsia. And 2 007. 76 mg / ml as predictive cut- off value is relatively ideal for postpartum hemorrhage.