晚孕期母血浆凝血酶、纤维蛋白原、D二聚体与妊娠期高血压疾病的相关性及诊断价值

Correlation and diagnostic value of maternal plasma thrombin,fibrinogen and D-dimer in last trimester with gestational hypertension

目的评价妊娠第28~32周孕妇血浆凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)、活化部分凝血酶原时间(activated partial prothrombin time,APTT)、纤维蛋白原(fibrinogen,FIB)和D-二聚体(D-dimer,D-D)水平与妊娠期高血压疾病的相关性及诊断价值。方法回顾性分析医院产科住院分娩的2355例孕妇资料,其中,1814例正常孕妇、286例妊娠高血压(gestational hypertension,GH)、143例子痫前期(preeclampsia,PE)和112例重度子痫前期(severe preeclampsia,SPE),采用受试者工作特征曲线(receiver operating characteristic curve,ROC)评价血浆凝血酶功能、FIB、D-D水平对妊娠期高血压疾病的相关性及诊断价值。结果GH组、PE组、SPE组的PT、FIB、D-D水平与正常组比较,各组间TT和APTT水平比较,差异均有统计学意义(均P<0.01)。PT、FIB和D-D对GH有诊断价值,D-D对PE有诊断价值,TT和D-D对SPE有诊断价值,PT(AUC=0.565)和D-D(AUC=0.575)对妊娠期高血压疾病有一定的诊断价值(P<0.001)。结论晚孕期孕妇凝血系统各指标与GH、PE有一定的相关性,PT和D-D水平对妊娠期高血压疾病具有一定诊断价值。

Objective To evaluate the correlation and diagnostic value of plasma prothrombin time(PT),thrombin time(TT),activated partial prothrombin time(APTT),fibrinogen(FIB)and D-dimer(D-D)levels with hypertensive disorders in pregnancy between the 28th and 32nd weeks of gestation.Methods This study retrospectively analyzed 2355 pregnant women who delivered in the obstetrics department,of which 1,814 were healthy pregnant women,286 had gestational hypertension(GH),143 had preeclampsia(PE),and 112 had severe preeclampsia(SPE).The relevance and diagnostic value of plasma thrombin function,FIB and D-D levels on gestational hypertension were analyzed using the receiver operating characteristic curve(ROC).Results The levels of PT,FIB and D-D in the GH,PE and SPE groups were statistically significantly different from the normal group.There were differences in TT and APTT levels between each group.(all P<0.01).PT,FIB,and D-D had diagnostic values for GH and D-D for PE.TT and D-D for SPE.PT(AUC=0.565)and D-D(AUC=0.575)had diagnostic values for gestational hypertension disorders(P<0.001).Conclusions There was a correlation between the indexes of coagulation and GH and PE during pregnancy.PT and D-D levels had definitive diagnostic values for hypertensive disorder in pregnancy.PT and D-D levels were of diagnostic value for gestational hypertension.