胎次对不同糖耐量母体产前凝血相关指标影响的临床研究

Clinical Research of Parity Effects on Maternal Prenatal Coagulation Related Indicators in Different Glucose Tolerance

目的 探讨胎次对孕期糖耐量正常（pregnancy with normal glucose tolerance,P-NGT）及妊娠期糖尿病（gestational diabetes mellitus,GDM）母体产前血钙、血小板计数及凝血功能指标的影响.方法 372例孕妇于建卡时详细询问病史,测量身高、体重、腰围及血压;孕24～28周行口服75 g葡萄糖耐量试验（oral glucose tolerance test,OGTT）及测定生化指标.GDM组与P-NGT组按婚育史中的生产次数分别将两组再细分为头胎及二胎亚组,检测入产房前血钙、血常规、凝血功能并记录分娩时出血量,并作统计学分析.结果 （1）无论糖耐量状态是否正常,二胎亚组血钙均低于头胎亚组;GDM组中,二胎亚组纤维蛋白原低于头胎亚组;分娩时出血量在头胎及二胎亚组间差异无统计学意义.（2）GDM组中胎次与血清总钙、纤维蛋白原、高密度脂蛋白及血红蛋白水平负相关.（3）线性回归分析显示：GDM组纤维蛋白原及血钙均与胎次负相关.结论妊娠晚期GDM人群胎次增加与血钙及纤维蛋白原下降相关,在其他影响凝血的因素（如血小板值、产科因素等）正常时,二者在正常范围内的变化未对分娩时出血量造成影响.

Objective To investigate the effect of parity on maternal serum calcium, platelet count and blood coagulation index in pregnancy with normal glucose tolerance （P-NGT） and gestational diabetes mellitus （GDM） matrix. Methods 372 pregnant women were asked for detailed medical history. Height, weight, waist circumference and blood pressure were measured. The 75 g oral glucose tolerance test （OGTT） and biochemical indexes were taken in 24 - 28 weeks. According to the marriage in the history of the number of production, GDM group and P-NGT group were subdivided into first and second sub group. The blood calcium, blood routine and coagulation function were detected before delivery, and the amount of bleeding during parturition was recorded and analyzed statistically. Results （1）Blood calcium in second subgroup were lower than the first sub group whether or not the blood sugar is normal; In GDM group, fibrinogen in the second birth subgroup is lower than the first birth group. Amount of bleeding during childbirth has no difference in first birth subgroup and second birth subgroup. （2）Parity were negatively correlated with serum calcium, fibrinogen, HDL and hemoglobin levels. （3）Linear regression analysis showed that fibrinogen and blood calcium were negatively correlated with parity.Conclusion In third trimester of GDM pregnancy, parity increasing is related to blood calcium and fibrinogen decreasing. When other factors that affect coagulation are normal, changes in the normal range of the two indexes did not affect the amount of bleeding during childbirth.