产后出血致弥散性血管内凝血的早期实验诊断探讨

Study of early laboratory diagnosis of disseminated intravascular coagulation in postpartum hemorrhage

目的 探讨早期诊断产后出血导致弥散性血管内凝血 (DIC)的可能性。方法 对 6 9例产妇按分娩时产后出血量分为 3组 ,第 1组 2 8例 ,出血量为 5 0 0～ 80 0ml;第 2组 11例 ,出血量 >80 0ml;第 3组 ,出血量<5 0 0ml,作为正常对照组。采用酶联免疫吸附法、发色底物法和免疫比浊法分别检测产时及产后 72h止凝血的分子标志物及常规凝血指标。结果 与对照组相比 ,产时 :第 1组的抗凝血酶活性 (AT :A)降低 ,D 二聚体(DD)升高 ;第 2组的AT :A、凝血酶 抗凝血酶复合物 (TAT)、纤维蛋白原 (Fg)、血小板 (BPC)下降 ,DD纤溶酶 抗纤溶酶复合物 (PAP)、活化部分凝血活酶时间 (APTT)、血浆凝血酶原时间 (PT)、凝血酶时间 (TT)上升。产后 :第 1组的TAT降低 ,DD升高 ;第 2组的AT :A、TAT下降 ,DD升高。产时第 2组Fg的下降及PT的上升与第 1组相比 ,差异有显著性 ,产后第 2组的抗凝血酶抗原 (AT :Ag)比第 1组下降更显著 (P <0 .0 0 5 )。每组的产后与产时比较 ,第 1组的AT :Ag、Fg明显上升 ,DD、PAP明显下降 ;第 2组的BPC显著上升 ,而第 2组的Fg上升较第1组更明显 (P <0 .0 0 5 )。结论 检测止凝血的分子标志物有助于早期诊断DIC。

Objective To appraise the possibility of early diagnosis of disseminated intravascular coagulation (DIC) in postpartum hemorrhage.Methods Molecular markers were measured in 39 patients who were divided into two groups according to the quantity of hemorrage (group 1, 28 patients, intrapartum hemorrhage 500～800 ml; group 2, 11 patients, intrapartum hemorrhage more than 800 ml) and 31 women with normal deliveries as control. Using ELISA, chromogenic peptide substrate assay and inmmunoturbid assay at the end of the delivery and 72 hours after delivery were measured. Conventional coagulation tests were also measured at the same time. Results Compared with the control at the end of the delivery in group 1, the antithrombin activity(AT:A)was decreased, but the D Dimer (D D) was decreased, in group 2, AT:A,thrombin antithrombin complex (TAT), fibrinogen (Fg), blood platelet count (BPC) were decreased; whereas the D D,plasmin antiplasmin complex (PAP), activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT) were elevated; 72 hours after delivery, in group 1, TAT was deceased and D D elevated, in group 2, AT:A,TAT were decreased and D D increased; the lowering of Fg, antithrombin antigen (AT:Ag), increase of PT were higher in group 2 than those in group 1( P <0.005).Conclusion Determination of the molecular markers of coagulation (AT,DD,PAP) are beneficial for early diagnosis of DIC.