剖宫孕妇及其窒息新生儿FIB、DD、AT-Ⅲ的临床研究

Clinical research on the plasma levels of fibrinogen, D- dimer and antithrombin Ⅲ in pregnant women undergoing caesarian section and their neonates

目的分析剖宫孕妇及其窒息新生儿的血浆纤维蛋白原（FIB）、D-二聚体（DD）、抗凝血酶Ⅲ（AT-Ⅲ）水平，探讨其与新生儿窒息的关系。方法选取在我院剖宫分娩的67对孕妇及新生儿，分为A、B、C组；A组为窒息组（n=25），孕妇有高危疾病和胎儿宫内窘迫，新生儿窒息；B组为非窒息组（n=19），孕妇有高危疾病和胎儿宫内窘迫，新生儿无窒息；C组为对照组（n=23），孕妇及新生儿健康。检验并分析各组母婴的血浆FIB、DD、AT-Ⅲ水平，对A组母婴3个凝血指标行相关性分析，采用受试者工作特征（ROC）曲线分析母亲3个指标对新生儿窒息的预测效能。结果A组孕妇及新生儿与B、C组比较，DD水平均明显升高（P〈0．05）；A组孕妇AT-Ⅲ水平较B、C组低（P〈0．05），B组孕妇AT-Ⅲ水平较A、C组高（P〈0．05），各组间新生儿AT-Ⅲ水平差异无统计学意义（P〉0．05）。A组孕妇及新生儿FIB水平较C组低（P〈0．05），而与B组差异无统计学意义（P〉0．05）。A组母婴DD水平成正相关（r=0．429，P〈0．05），FIB、AT-Ⅲ水平无相关。ROC曲线下面积：孕妇DD曲线下面积为0．902，敏感度88．0％，特异度76．2％；AT—Ⅲ曲线下面积为0．819，特异度92．0％；FIB曲线下面积为0．627。结论孕妇的血浆DD水平可预测新生儿窒息，联合AT-Ⅲ及FIB有助于判断剖宫产的时机，防止新生儿窒息。

Objective To investigate the levels of plasma fibrinogen （FIB）, D -dimer （DD） and antithrombin Ⅲ （AT - Ⅲ） in pregnant women undergoing caesarian section and their neonates, so as to discuss their relationship with neonatal asphyxia. Methods A total of 67 pairs of pregnant women undergoing caesarian section and their neonates who were admitted in our hospital were enrolled in this study. They were divided into Groups A, B, and C. Group A was an asphyxia group （n = 25）, including pregnant women with high risks of diseases and fetal distress, and neonates with asphyxia. Group B was a non - asphyxia group （ n = 23）, including pregnant women with high risks of diseases and fetal distress, and neonates without as- phyxia. Group C was a control group （n = 19）, including healthy pregnant women and neonates. The levels of serum FIB, DD and AT - Ⅲ in all subjects were analyzed. The correlation about the levels of serum FIB, DD and AT - Ⅲ between pregnant women and neonates in Group A was investigated by a receiver operation characteristic （ROC） curve. Results Both pregnant women and neonates in Group A produced higher DD levels than those in Groups B and C （P 〈 0. 05）. A lower level of plasma AT- Ill was detected in the pregnant women in Group A than those in Groups B and C （P 〈0.05）. There was no statistical difference as to AT -llI level among the neonates of the three groups （P 〉0. 05）. Both pregnant women and neonates in Group A presented lower FIB levels than those in Group C （P 〈 0. 05）, bat without statistical difference with those in Group B （ P 〉 0. 05）. The levels of serum DD in pregnant women and neonates of Group A was positively correlated （r =0.429, P 〈0. 05 ）. For the pregnant women in Group A, the areas under the ROC curve （ AUC ） of serum DD was 0. 902, with sensitivity 88. 0%, specificity 76. 2% ; AT - Ⅲ AUC was 0. 819, with specificity 92. 0% ; FIB AUC was 0. 627. Conclusions The level of plasma DD in pregnant women is useful to predict neonatal asphyxia, and can facilitate determination of the time of caesarian section to prevent neonatal asphyxia, especially when combined with the levels of AT - Ⅲ and FIB.