D-二聚体在孕早期不明原因复发性流产患者中临界值的探讨

Cutoff value of D-dimer in patients with unexplained recurrent spontaneous abortion during early pregnancy

目的探讨不明原因复发性流产患者早孕期D-二聚体水平及临界值。方法收集2013年6月至2017年6月在本院妇科就诊患者2 975例,按本次生育意愿及既往有无不明原因复发性流产史分为三组:其中门诊行人工流产术、既往无稽留流产史的早孕患者为早孕组(NEP组,n=1 160);此次为宫内早孕、单活胎、既往有≥2次稽留流产的患者为复发性流产早孕组(AEP组,n=673);既往稽留流产史的早孕患者且此次未孕患者为复发性流产未孕组(ANP组,n=1 142)。所有患者均行D-二聚体水平检测,AEP及NEP患者同时进行血同型半胱氨酸(Hcy)、活化蛋白C抵抗试验(APC-R)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)检查,分析各个指标的组间差异,采用GraphPad 6.0对数据进行分析,采用受试者工作特征曲线下面积(AUC)计算临界值,计算D-二聚体及其它各指标在不明原因复发性流产再次妊娠中的临界值。结果 (1)三组患者的年龄、体重指数(BMI)、孕次及基础FSH、抗苗勒管激素(AMH)水平均无显著性差异(P>0.05)。(2)三组患者D-二聚体的临界值分别为0.65mg/L、0.51mg/L、0.57mg/L,与AEP组相比,NEP及ANP组显著降低(P<0.05)。(3)AEP和NEP组各指标的比较统计结果显示:D-二聚体的临界值是0.65 mg/L,D-二聚体AUC曲线下面积是0.89,阳性预测值90.24%,阴性预测值72.67%,均有统计学意义(P<0.05),Hcy、PT临界值分别是9.75μmol/L、12.85s,差异有统计学意义(P<0.05),而APC-R、APTT则无显著性差异(P>0.05),对预测不明原因复发性流产无统计学意义。结论早期复发性流产早孕患者D-二聚体水平显著升高,存在血栓形成倾向,检测D-二聚体可预测复发性流产患者发生血栓的可能性,改善妊娠结局。

Objective:To investigate the cutoff value of D-dimer in the patients with unexplained recurrent spontaneous abortion(URSA)during early pregnancy.Methods:A total of 2 975 patients were enrolled in the study in Department of Obstetrician and Gynecologist of People’s Hospital of Wenzhou.The patients were divided into 3 groups:the early pregnancy patients without abortion history who underwent abortion were included in the outpatient clinic in NEP group(n=1 160);the patients with≥2 times missed abortion history who had early intrauterine single pregnancy were included in AEP group(n=673);the patients with missed abortion history and without pregnancy were included in ANP group(n=1 142).All patients underwent D-dimer level testing.The patients in AEP and NEP group also had the test of blood homocysteine(Hcy),activated protein C resistance(APC-R),prothrombin PT,and partial thromboplastin time(APTT).The differences of various indicators were analyzed by using GraphPad 6.0 among the groups.The area under the receiver operating characteristic curve(ROC),i.e.AUC,was used to calculate the cutoff value.The cutoff values of D-dimer and other indicators were calculated in the pregnancy patients with unexplained recurrent abortion.Results:There was no significant difference in age,body mass index(BMI),gravidity,basic levels of FSH and anti-Mullerian hormone(AMH)among the three groups(P>0.05).The cutoff value of D-dimer in three groups was 0.65,0.51 and 0.57 mg/L,respectively.The cutoff value of NEP and ANP group was significantly decreased compared with AEP group(P<0.05).Comparison of indexes in AEP and NEP groups showed that the cutoff value of D-dimer was 0.65 mg/L;the AUC of D-dimer was 0.89,with a positive predictive value of 90.24%and a negative predictive value of 72.67%;all of the indicators had statistical significance(P<0.05).The cutoff value of Hcy(9.75μmol/L)and PT(12.85 s)also had statistical significance(P<0.05).There were no significant differences in APTT and APC-R among the groups,which had no significant difference in predicting unexplained recurrent abortion.Conclusions:The D-dimer levels in patients with early recurrent abortion significantly increased,and there is a tendency to thrombosis.Detection of D-dimer can predict the possibility of thrombosis in patients with recurrent abortion and improve pregnancy outcomes.