妊娠期女性常规凝血指标参考范围建立

The Establishment of Reference Range of Routine Coagulation Indicators in Pregnant Women

目的研究本地区妊娠期女性常规凝血指标凝血酶原时间(PT),活化部分凝血活酶时间(APTT),凝血酶时间(TT),纤维蛋白原(FIB),D-二聚体(D-dimer)在不同孕期水平变化,建立适用于本实验室的妊娠期女性常规凝血指标的参考范围。方法选择2016年7月至2017年7月间在北京妇产医院建档的健康孕妇1068例,分为孕早期组333例、孕中期组240例、孕晚期组355例及非孕妇女140例。参照美国临床实验室标准化协会(CLSI)的C28-A3文件,最终建立妊娠期女性常规凝血指标的参考范围。结果研究结果显示,D-dimer与FIB均随着孕周的增长而升高,组间差异具有统计学意义(P<0.05),APTT、PT孕中、晚期较孕早期有缩短趋势,TT孕中期较孕早期有缩短趋势。结论实验室应建立妊娠期女性不同孕期常规凝血指标的参考区间,密切监测孕妇产前凝血功能指标,了解其妊娠期凝血与纤溶功能的变化,对提高分娩安全,预防妊娠期母胎并发症,具有重要指导意义。

Objective To study the changes of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB)and D- dimer in different gestational stages of pregnant women in this region,and to establish the reference ranges of routine coagulation indexes for pregnant women in our laboratory. Methods A total of 1,068 healthy pregnant women registered in Beijing Obstetrics and Gynecology Hospital from July,2016 to July,2017 were divided into the early pregnancy group(n=333),mid- pregnancy group(n=240),late pregnancy group(n=355)and non- pregnant women group(n=140).According to the C28- A3 document of CLSI,the reference range of routine coagulation parameters for pregnant women was established. Results The results showed that D- dimer and FIB increased with the increase of gestational weeks,and there were statistical differences between groups( P <0.05).APTT and PT had a decreasing trend in the middle and late stages of pregnancy than in the early stages,while TT had a decreasing trend in the middle stages of pregnancy than in the early stages. Conclusion The reference intervals of routine coagulation indexes in different gestational stages should be established among pregnant population.A close monitoring of prenatal coagulation function of pregnant women and a deep understanding of the changes of coagulation and fibrinolysis during pregnancy are of great importance for improving the safety of delivery and preventing complications of pregnancy and fetus.