低危妊娠女性孕晚期D-二聚体和纤维蛋白原的参考值范围及意义

Initial Establishment of D-dimer and Fibrinogen Reference Range and Its Clinical Significance in Low Risk Pregnant Women during Third Trimester

目的建立低危妊娠女性孕晚期D-二聚体和纤维蛋白原的参考区间,并探讨其临床意义。方法搜集2013年1月~2016年6月在温州市人民医院住院分娩的健康产妇共21788例(28~42周),分别统计其分娩前1周内的血浆D-二聚体和纤维蛋白原浓度,分析其与年龄、孕周的关系。D-二聚体参考区间采用百分位数(P95)表示参考区间的单侧上限,纤维蛋白原参考区间采用双侧百分位数法表示(P2.5~P97.5)。并以此评估618例产后出血和5例围生期静脉血栓的病例。结果孕晚期女性D-二聚体随着孕周增加而逐渐上升(r=0.07,P=0.000)而纤维蛋白原浓度水平随孕周逐渐下降(r=-0.09,P=0.000)。D-二聚体和纤维蛋白原浓度水平均与女性分娩年龄呈正相关(r分别为0.05和0.02,P=0.000)。孕晚期女性血浆D-二聚体参考区间为≤3.16mg/L,纤维蛋白原参考区间为3.23~6.06g/L。高于此D-二聚体参考区间或低于此纤维蛋白原参考区间的病例中,产后出血的比例明显增加,差异有统计学意义(P<0.05)。评估的5例围生期静脉血栓病例,4例阳性。结论建立低危妊娠女性孕晚期D-二聚体和纤维蛋白原的参考值范围,指导临床医生正确认识孕晚期D二聚体升高对孕产妇的意义,对预防产后出血及围生期静脉血栓具有指导意义。

Objective To establish D - dimer and fibrinogen reference range in Low risk pregnant women during third trimester, and explore its clinical significance. Methods D - dimer and fibrinogen levels were measured in 21788 pregnant women （ gestational age 28 - 42weeks） from January 2013 to June 2016 in Wenzhou People＇ s Hospital. D -dimer and fibrinogen were measured antepartum（ less than one week before delivery）. The normal reference intervals（one tails） of D - dimer reference range were established by using 95% percen- tile method, while fibrinogen were defined as 2.5% -97.5%. We analyzed the clinical significance of the reference range for predicting the postpartum hemorrhage And the results of 5 patients were used to validate the established normal values. Results D - dimer increased physiologically with gestational age in late pregnancy（ r = 0.07 ,P = 0. 000） , while fibrinogen decreased with gestational age（ r = -0.09, P = 0. 000）. The levels of D - dimer and fibrinogen had a positive correlation with the age of the pregnant women. Reference intervals of D - dimer and fibrinogen at late pregnancy in healthy pregnant women were as following：the D - dimer levels were ~〈 3.16mg/L, the fibrin- ogen levels were 3.23 - 6.06g/L. The incidence rate of postpartum hemorrhage was higher in group with abnormal D - dimer and fibrino- gen. And four of five patients with venous thrombosis showed positive results with the D - dimer normal value. Conclusion The establish- ment of reference intervals for D - dimer and fibrinogen in late pregnancy will help to distinguish abnormal D - dimer and fibrinogen in late pregnancy,which will improve the use of the value of D - dimmer and fibrinogen in pregnancy and the D - D. The fibrinogen levels in the third trimester could be helpful to predict postpartum hemorrhage, and venous thrombosis.