D-二聚体对反复种植失败患者妊娠结局的预测价值

Predict value of D-dimer for pregnancy outcome in patients with repeated implantation failure(RIF)in IVF-ET cycle

目的探讨D-二聚体与反复种植失败(RIF)患者体外授精-胚胎移植(IVF-ET)后妊娠结局的预测价值。方法 2016年1月至2017年1月在本院就诊的RIF患者在IVF-ET后验孕日(2周),孕早期(6~12周),孕中期(13~24周)以及孕晚期(25~37周)均需抽取枸橼酸钠抗凝血,使用Mini VIDAS全自动化荧光酶标免疫测试系统进行D-二聚体检测。本研究通过回顾性分析,根据妊娠结局将患者分为种植失败组、种植成功(自然流产和成功分娩)组,比较组间D-二聚体水平以及妊娠期D-二聚体水平在孕期的变化情况。结果验孕日,种植失败组与种植成功(自然流产和成功分娩)组的D-二聚体浓度无显著性差异(205ng/ml vs.194ng/ml,P>0.05);孕早期(6~12周),自然流产组与成功分娩组D-二聚体浓度无显著性差异(276ng/ml vs.237ng/ml,P>0.05);成功分娩组患者的D-二聚体浓度随着孕期逐渐升高(F=20.3,P<0.001),并且与孕期呈显著正相关关系(r=0.762,P<0.001)。结论 D-二聚体水平与RIF患者IVF-ET后的种植失败无显著相关性,孕早期D-二聚体的浓度对其早期流产无预测价值,临床医生应根据RIF患者的不同妊娠期的D-二聚体浓度参考范围进行血栓前状态诊断。

Objective：To investigate the predict value of D-dimer for pregnancy outcome of patients with repeated implantation failure（RIF）in IVF-ET cycle.Methods：The RIF patients visited our fertility center from Jan,2016 to Jan,2017 were enrolled in this study.The blood samples were collected by anticoagulation with sodium citrate at 2 weeks after IVF-ET,first trimester（6-12 weeks）,second trimester（13-24 weeks）,third trimester（25-37 weeks）.Then D-dimer was detected by Mini VIDAS fully automated fluorescence enzyme immunity test system.According to pregnancy outcome,the RIF patients were divided into implantation failure group and implantation success group（miscarriage group and successful delivery group）.The D-dimer concentration and changes during pregnancy were compared among the groups.Results：The D-dimer concentration was not significantly different at 2 weeks after IVF-ET between implantation failure group and implantation success group（miscarriage and successful delivery group）（205 vs.194 ng/ml,P〈0.05）.During first trimester period（6-12 weeks）,there is no significant difference in D-dimer concentration between miscarriage group and successful delivery group（276 vs.237 ng/ml,P〈0.05）.The D-dimer concentration gradually increased with gestation period in the successful delivery group（F=20.3,P〈0.001）,and it was positively correlated with gestation period（r=0.762,P〈0.001）.Conclusions：No significant association was found between D-dimer concentration and implantation failure in the RIF patients.D-dimer during first trimester has no predict value for early miscarriage in RIF patients.The clinicians should discreetly evaluate the prothrombosis state according to the reference range of D-dimer concentration during different gestation period.