妊娠晚期女性凝血四项、纤维蛋白(原)降解产物及D-二聚体水平变化及临床意义

Changes and clinical significance of blood coagulation four items,FDF,and D-dimer levels during the third trimester of pregnancy

目的检测妊娠晚期女性凝血四项、纤维蛋白(原)降解产物(FDP)及D-二聚体(DD)水平,分析其变化及临床意义,为临床提供参考依据。方法选取2016年1月-12月就诊的9 200例妊娠晚期女性为妊娠晚期组,选取同期的1 200例健康非妊娠女性为健康对照组。采集两组女性清晨空腹静脉血,检测凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、纤维蛋白(原)降解产物(FDP)及D-二聚体(DD)水平。根据孕周将妊娠晚期组分为Ⅰ组(31~37孕周)、Ⅱ组(38~40孕周)、Ⅲ组(41~42孕周),比较不同孕周女性PT、TT、APTT、FIB、FDP及DD水平。结果与健康对照组比较,妊娠晚期组女性PT、TT、APTT均明显缩短,FIB、FDP及DD水平均明显升高,差异均有统计学意义(均P<0.05)。Ⅰ组与Ⅱ组PT、TT、APTT、FIB、FDP、DD比较,差异均有统计学意义(均P<0.05);Ⅰ组与Ⅲ组PT、TT、APTT、FIB、FDP、DD比较,差异均有统计学意义(均P<0.05);Ⅱ组与Ⅲ组PT、TT、APTT、FIB、FDP、DD比较,差异均无统计学意义(均P>0.05)。结论妊娠晚期女性机体处于高凝状态,动态监测凝血功能指标可指导临床合理治疗及用药。

Objective To detect the levels of blood coagulation four items,fibrin degradation product（ FDF） and D-dimer（ DD） during the third trimester of pregnancy,analyze the changes and clinical significance,and provide reference basis in the clinic. Methods A total of 9 200 pregnant women during the third trimester of pregnancy were selected from the hospital from January to December in 2016 as late pregnancy group,1 200 healthy non-pregnant women during the same period were selected as healthy control group. The fasting venous blood samples of the women in the two groups were collected,prothrombin time（ PT）,thrombin time（ TT）,activated partial thromboplastin time（ APTT）,the levels of fibrinogen（ FIB）,FDP,and DD were detected. According to gestational week,the women in late pregnancy group were divided into group Ⅰ（ 31-37 weeks of gestation）,group Ⅱ（ 38-40 weeks of gestation） and group Ⅲ（ 41-42 weeks of gestation）,the levels of PT,TT,APTT,FIB,FDP,and DD of women in different gestational week groups were compared. Results Compared with healthy control group,PT,TT,and APTT in late pregnancy group significantly shortened,while the levels of FIB,FDP,and DD significantly increased,and the differences were statistically significant（ P〈0. 05）. There were statistically significant differences in PT,TT,APTT,the levels of FIB,FDP,and DD between group Ⅰ and group Ⅱ（ P〈0. 05）; there were statistically significant differences in PT,TT,APTT,the levels of FIB,FDP,and DD between group Ⅰ and group Ⅲ（ P〈0. 05）; there were statistically significant differences in PT,TT,APTT,the levels of FIB,FDP,and DD between group Ⅱ and group Ⅲ（ P〈0. 05）. Conclusion The pregnant women during the third trimester of pregnancy are in hypercoagulable state,dynamical monitoring of coagulation function indexes can guide reasonable clinical treatment and medication.