血浆D-二聚体与子痫前期-子痫严重程度的相关性分析

Correlation analysis of plasma D-dimer and severity of preeclampsia-eclampsia

目的评估D-二聚体与子痫前期-子痫严重程度的相关性及临床诊断价值。方法回顾性分析136例子痫前期-子痫患者(其中子痫前期患者58例、重度子痫前期患者76例,子痫2例)的临床资料,包括检测其分娩时血浆D-二聚体浓度,统计伴发的严重表现,分析D-二聚体与子痫前期-子痫严重程度的相关性。结果所有入选患者的D-二聚体浓度均超出正常范围(>0.55 mg/L)。重度子痫前期孕妇的D-二聚体中位浓度显著高于子痫前期孕妇[2.97mg/L(1.11~9.29 mg/L)vs 1.61 mg/L(0.62~7.11 mg/L);P<0.05],特别是在伴有上腹部疼痛和(或)转氨酶升高的患者中。重度子痫前期患者的发病孕周早于子痫前期患者。血浆D-二聚体诊断重度子痫前期的受试者操作特征(ROC)曲线曲线下面积为0.80,当D-二聚体浓度为1.79mg/L时,预测重度子痫前期的敏感性为76.9%,特异性为77.6%,95%CI(置信区间)为0.72~0.87。结论血浆D-二聚体水平与子痫前期-子痫严重程度密切相关,可作为初步判断病情严重程度的指标之一,预测重度子痫前期的发生。

Objective To evaluate the correlation between D-dimer and severity of preeclampsia-eclampsia and its clinical diagnostic value. Methods Retrospective analysis of 136 cases of preeclampsia-eclampsia(There were 58 cases of preeclampsia, 76 cases of severe preeclampsia and 2 cases of eclampsia) was made, including the concentration of D-dimer at delivery, the accompanying clinical manifestations, and the correlation between D-dimer and disease severity. Results In this study population, D-dimer concentration in pregnant women was beyond the normal range(>0.55 mg/L). The median D-dimer concentration of pregnant women in the severe preeclampsia group was significantly higher than that in the preeclampsia group [2.97 mg/L(1.11-9.29 mg/L) vs. 1.61 mg/L(0.62-7.11 mg/L);P<0.05], especially in patients with upper abdominal pain and/or elevated transaminases, although their earlier gestational ages of sampling. The ROC(receiver operator characteristic curve) area under the ROC curve for diagnosis of severe preeclampsia with plasma D-dimer was 0.80. When the cutoff value was 1.79 mg/L, the sensitivity, specificity and 95%CI(confidence interval) for predicting severe preeclampsia were 76.9%, 77.6% and 0.72-0.87. Conclusion Plasma D-dimer level is closely related to the severity of preeclampsia-eclampsia,and can be used as one of the indicators to preliminarily judge the severity of the disease and predict the occurrence of severe preeclampsia.