子痫前期患者血浆D-二聚体与C-反应蛋白水平的相关性及诊断意义

Correlation between plasma D-dimer and C-reactive protein levels of preeclampsia patient and their diagnositic significance

目的分析子痫前期患者血浆D-二聚体、C-反应蛋白(CRP)及凝血四项水平,探讨上述指标与子痫前期的相关性,为子痫前期的临床诊断及严重程度的评估提供参考。方法回顾并分析2019年1月—2021年9月徐州市妇幼保健院收治的257例孕妇的临床资料,包括117名正常妊娠孕妇,66例轻度子痫前期孕妇以及74例重度子痫前期孕妇。检测所有孕妇血浆D-二聚体、CRP及凝血四项〔凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、凝血酶时间(TT)〕;采用二元Logistic回归分析校验D-二聚体及CRP水平与疾病严重程度的相关性;采用Spearman相关性分析检验D-二聚体与CRP、新生儿出生体质量、1 min及5 min Apgar评分的相关性;绘制受试者工作特征曲线(ROC曲线)并计算ROC曲线下面积(AUC),评估D-二聚体对重度子痫前期的诊断价值。结果子痫前期孕妇的PT明显少于正常妊娠孕妇,TT、CRP水平均明显高于正常妊娠孕妇〔PT(s):10.94±0.84比11.66±0.55,TT(s):16.54±1.62比15.81±0.84,CRP(mg/L):12.35±8.01比6.06±5.52,均P<0.05〕。重度子痫前期孕妇血浆中D-二聚体水平相比轻度子痫前期者明显增高(mg/L:2.98±1.97比2.27±1.56,P<0.05),CRP水平较轻度子痫前期者稍高,但差异无统计学意义(mg/L:14.96±11.81比9.74±8.13,P>0.05)。Spearman相关性分析显示,子痫前期患者血浆D-二聚体与CRP呈正相关(r=0.225,P=0.008);二元Logistic回归分析结果表明,D-二聚体与子痫前期病情严重程度呈正相关〔优势比(OR)为1.264,95%可信区间(95%CI)为1.028~1.553,P=0.026〕;ROC曲线分析显示在截断值为2.12 mg/L时,D-二聚体对重度子痫前期诊断的AUC为0.595(95%CI为0.512~0.677),敏感度为63.5%,特异度为58.5%。结论孕晚期子痫前期孕妇存在凝血-纤溶功能失衡,血浆中D-二聚体水平与子痫前期病情严重程度呈正相关,且子痫前期孕妇D-二聚体与CRP水平呈正相关,应定期对子痫前期孕妇进行凝血-纤溶功能检测,给予合理的临床管理和干预。

Objective To analyze the levels of D-dimer,C-reactive protein(CRP)and blood clotting tetrachoric in preeclampsia patients,and explore the correlations between the above indexes and preeclampsia,thus provide reference for the diagnosis and evaluation of disease severity.Methods The clinical data of 257 pregnant women from January 1,2019 to September 30,2021 admitted in Xuzhou Maternity and Child Health Care Hospital were retrospectively analyzed.The pregnant women included 66 cases with mild preeclampsia pregnancies,74 cases with severe pregnancies and 117 healthy pregnant women.The levels of D-dimer,CRP and blood clotting tetrachoric[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib)and thrombin time(TT)]were detected.Binary Logistic regression analysis was applied to analyzing the correlation between D-dimer and CRP levels and disease severity.The spearman correlation analysis was used to analyze the correlation between D-dimer level and CRP,birth weight,1 minute and 5 minute Apgar score.Receiver operator characteristic(ROC)curve was drawn and area under ROC curve(AUC)was calculated to determine the diagnostic ability of D-dimer for severe preeclampsia.Results The PT level of preeclampsia pregnant women was lower than healthy pregnant women,while TT and CRP levels were higher[PT(second):10.94±0.84 vs.11.66±0.55,TT(second):16.54±1.62 vs.15.81±0.84,CRP(mg/L):12.35±8.01 vs.6.06±5.52,all P<0.05].The plasma D-dimer level in severe preeclampsia was higher than that in mild preeclampsia(mg/L:2.98±1.97 vs.2.27±1.56,P<0.05),and the CRP level was slightly higher in women with mild preeclampsia,but there was no statistical difference(mg/L:14.96±11.81 vs.9.74±8.13,P>0.05).Spearman correlation analysis showed a positive correlation between D-dimer and CRP levels in preeclampsia pregnancy women(r=0.225,P=0.008).Binary Logistic regression analysis showed a positive correlation between D-dimer level and preeclampsia severity[odds ratio(OR)=1.264,95%confidence interval(95%CI)was 1.028-1.553,P=0.026].Under the cutoff value of 2.12 mg/L,the AUC for D-dimer for severe preeclampsia diagnosis was 0.595(95%CI was 0.512-0.677),and the sensitivity and specificity were 63.5%and 58.5%,respectively.Conclusions Dysregulated coagulation-fibrinolysis is present in late pregnancy of preeclampsia.The plasma D-dimer level was positively correlated with the severity of preeclampsia.Moreover,there might be a positive correlation between D-dimer and CRP levels.Therefore,regular monitoring on coagulation-fibrinolysis function should be performed in pregnant women for the rational clinical management and treatment.