高龄产妇分娩前后D-二聚体水平变化特点及其临床意义

Characteristics and clinical significance of serum D-dimer level before and after delivery in women with advanced maternal age

目的探讨高龄产妇分娩前后血浆D-二聚体水平变化的特点及其对诊断静脉血栓栓塞性疾病(VTE)的临床意义。方法选取2017年1月1日至12月31日在浙江大学医学院附属妇产科医院分娩的785例高龄产妇作为研究对象;同时随机选取327例同期分娩的适龄产妇作为对照,比较两组产妇分娩前后的血浆D-二聚体水平;观察产后D-二聚体明显升高的高龄产妇的转归情况。同时搜集浙江大学医学院附属妇产科医院2014至2018年并发VTE的产妇资料,分析其临床特点及其D-二聚体水平变化情况。结果高龄产妇与适龄产妇间分娩前和分娩后血浆D-二聚体水平间的差异均无统计学意义[分娩前1.64(1.19,2.29)mg/L比1.53(1.04,2.23)mg/L,分娩后2.70(1.71,2.97)mg/L比2.63(1.17,4.13)mg/L,均P>0.05];产后高水平D-二聚体的高龄产妇中,其D-二聚体水平在4 d内大幅下降[下降幅度为9.2(7.69,12.74)mg/L,下降幅度达50%者占比为96.2%],且所有产妇均未发生VTE。近4年间(2014至2018年)共搜集到8例并发VTE的产妇(其中5例为高龄产妇);这些产妇均因下肢不适或产后D-二聚体水平变化异常(下降缓慢或不降反升)而行B超检查确诊,且均发生于剖宫产后第3~5天。结论高龄因素对分娩前后的血浆D-二聚体水平影响较小,单一的血浆D-二聚体水平测定对VTE的预测诊断意义有限,而严密监测产妇的临床症状及血浆D-二聚体水平的动态变化有助于VTE的早期诊断。

Objective To explore the characteristics of serum D-dimer level before and after delivery in women with advanced maternal age(VTE),and to assess the value of the characteristics for the diagnosis of venous thromboembolic disease.Methods The objects were 785 puerperae with advanced maternal age(AMA)who experienced delivery in Women′s Hospital,Zhejiang University School of Medicine during 1st Jan 2017 to 31st Dec 2017,and 327 puerperae with appropriate maternal age as controls were randomly selected from puerperae who gave birth in the same period.Their serum D-dimer levels before and after delivery were evaluated,and AMAs with high-level postnatal serum D-dimer were specially observed for the prognosis.Besides,puerperae complicated with VTE were retrieved from the medical database during 2014-2018,and their clinical characteristics and dynamic variation of serum D-dimer levels were analyzed.Result The significant difference of D-dimer levels neither before nor after delivery was not observed between AMAs and controls(antenatal:1.64(1.19,2.29)mg/L vs 1.53(1.04,2.23)mg/L,and postnatal:2.70(1.71,2.97)mg/L vs 2.63(1.17,4.13)mg/L,P<0.05 for both;None of AMAs with high-level serum D-dimer after delivery were complicated with VTE,and most of their serum D-dimer levels decreasedsharply with in four postnatal days(the average decrease was 9.2(7.69,12.74)mg/L,and 96.2%of the sepuerperae′s decrease was more than 50%).Eight puerperae complicated with VTE were found in the database from 2014 to 2018,among which five were AMAs.The eight puerperae all received a B ultrasound because of the discomfort of lower limbs or abnormal variation of serum D-dimer levels(a slow decrease or an increase trend),so that a diagnosis of VTE was established;besides,the diagnosis or symptoms all emerged in the 3rd to 5th day after caesarean.Conclusions The factor of advanced maternal age has little influence on the serum D-dimer level before or after delivery among pregnant women.It is not a single detection for serum D-dimer level,but the intensive monitoring of clinical symptoms and dynamic change of serum D-dimer level,that helps early diagnosis of VTE.