妊娠期凝血功能参考区间建立对产妇静脉栓塞及产后出血的预测作用

To predict of Establishing Reference Interval of Coagulation Function in Pregnancy for Maternal Venous Embolism and Postpartum Hemorrhage

目的研究妊娠期凝血功能参考区间对产妇静脉栓塞及产后出血的预防指导作用。方法将从2017年1月1日-2019年12月31日于某院进行规律产检和分娩的妊娠期女性720例作研究组。另取同期进行体检的非妊娠期女性100例作为对照组。检测并对比研究组不同妊娠周期以及对照组的各项凝血功能参数水平,分析妊娠期女性静脉栓塞和产后出血的发生和不同孕期D-二聚体水平的关系。此外,比较研究组产妇临产期(孕周>37周)以及产褥期(产后1天~5天)的凝血功能相关参数水平。结果研究组的纤维蛋白原(FIB)、D-二聚体水平均高于对照组,而血小板计数(PLT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)水平均低于对照组;且孕中期、孕晚期的D-二聚体水平均高于孕早期,孕晚期D-二聚体水平又高于孕中期(均P<0.05)。孕早期FIB、D-二聚体、PLT、PT、APTT、TT的参考区间分别是2.73~5.08g/L、1.05μg/ml、136~310×10^(9)/L、11.61~14.33s、29.20~48.21s、14.33~20.10s;孕中期各项凝血功能参数的参考区间分别是3.18~5.09g/L、2.04μg/ml、121~320×10^(9)/L、11.50~14.66s、29.01~46.49s、13.58~18.69s;孕晚期各项凝血功能参数的参考区间分别是3.15~6.04g/L、2.51μg/ml、117~321×10^(9)/L、11.32~13.80s、28.54~39.07s、13.43~18.61s。孕早期、孕中期、孕晚期发生静脉栓塞各有1例、2例、1例,其D-二聚体水平分别是2.73、9.12、15.42、13.01μg/ml,由此可知,上述4例产妇每次监测的D-二聚体水平均高于研究制定的相应孕期参考区间,结果均为阳性。孕晚期产后出血产妇共82例,其D-二聚体均值为4.95μg/ml,明显高于研究制定的相应孕期参考区间,其中有4例孕妇的D-二聚体水平处于研究制定的相应孕期参考区间之内。产褥期产妇的FIB、D-二聚体水平均高于临产期组,而PT、APTT以及TT水平均低于临产期组(均P<0.05)。结论妊娠期凝血功能参考区间的建立具有较佳的临床应用价值,其中D-二聚体和妊娠期女性静脉栓塞以及产后出血具有较高的预测作用,值得临床重点关注。

Objectives To study the preventive guidance function of reference interval for blood coagulation function in pregnancy and maternal venous embolism and postpartum hemorrhage. Methods From January 1 st, 2017 to December 31 st, 2019, 720 cases of pregnant women who underwent regular obstetric examination and delivery in hospital were included as research group. Another 100 non-pregnant women who underwent physical examination in hospital during the same period were selected as the control group. The levels of coagulation function parameters in the study group and the control group during different gestation cycles were detected and compared to analyze the relationship between the occurrence of venous embolism and postpartum hemorrhage in women during pregnancy and the levels of D-dimer in different pregnancies. In addition, the levels of coagulation function related parameters during parturival period(>37 weeks) and puerperium period(1-5 days postpartum) were compared in the study group. Results The levels of fibrinogen(FIB) and D-dimer in the study group were higher than those in the control group, while the levels of platelet count(PLT), activated partial thromboplastin time(APTT) and thrombin time(TT) were lower than those in the control group. The level of D-dimer in the second and third trimester of pregnancy was higher than that in the first trimester, and the level of D-dimer in the third trimester was higher than that in the second trimester(all P < 0.05). The reference intervals of FIB, d-dimer, PLT, PT, APTT and TT in early pregnancy were 2.73 ~ 5.08 g/L, 1.05 g/ml, 136 ~ 310×10^(9)/L, 11.61 ~ 14.33 s, 29.20 ~ 48.21 s, 14.33 ~ 20.10 s, respectively. The reference intervals of various coagulation function parameters in the second trimester were 3.18 ~ 5.09 g/L, 2.04 g/ml, 121 ~ 320×10^(9)/L, 11.50 ~ 14.66 s, 29.01 ~ 46.49 s, and 13.58 ~ 18.69 s, respectively. The reference intervals of coagulation function parameters in the third trimester were 3.15 ~ 6.04 g/L, 2.51 g/ml, 117 ~ 321×10^(9)/L, 11.32 ~ 13.80 s, 28.54 ~ 39.07 s, and 13.43 ~ 18.61 s, respectively. There were 1, 2 and 1 cases of venous embolism in the first, second and third trimesters of pregnancy, respectively, and the D-dimer levels were 2.73, 9.12, 15.42 and 13.01μg/m L, respectively. Therefore, the D-dimer levels monitored in the above 4 women were all higher than the corresponding reference interval of pregnancy established in this study, and the results were all positive. A total of 82 women with postpartum hemorrhage in the third trimester had an average D-dimer of 4.95μg/m L, which was significantly higher than the corresponding reference interval of pregnancy established in this study. Among them, the D-dimer level of 4 pregnant women was within the corresponding reference interval of pregnancy established in this study. The levels of FIB and D-dimer in puerperium were higher than those in parturient group, while the levels of PT, APTT and TT were lower than those in parturient group(all P<0.05). Conclusions The establishment of reference interval for blood coagulation function in pregnancy has a better clinical application value, among which d-dimer has a higher predictive effect on venous embolism and postpartum hemorrhage in pregnant women. Which is worthy of clinical attention.