血浆D-二聚体、抗凝血酶-Ⅲ及凝血四项指标对自然分娩产妇产后出血的预测价值

Predictive Value of Plasma D-dimer, Antithrombin-Ⅲ and Coagulation Four Indices Indicators for Postpartum Bleeding in Pregnant Women with Natural Delivery

目的:探究血浆D-二聚体、抗凝血酶-Ⅲ(AT-Ⅲ)及相关凝血四项指标对自然分娩产妇产后出血的预测价值,为自然分娩出血风险提供参考依据。方法:回顾性分析2020年1月—2021年9月武汉市江夏区第一人民医院妇产科收治的166例自然分娩产妇的临床资料,根据分娩后是否发生产后出血分为出血组(n=86)和对照组(n=80)。入选产妇均在怀孕32~37周时取清晨静脉血进行D-二聚体、AT-Ⅲ和凝血四项指标[凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)]检测。结果:出血组血浆D-二聚体表达水平显著高于对照组,AT-Ⅲ显著低于对照组,差异均有统计学意义(P<0.05)。两组的TT、APTT比较,差异无统计学意义(P>0.05);出血组的PT显著长于对照组,FIB显著低于对照组,差异均有统计学意义(P<0.05)。以入选产妇分娩后是否出血作为应变量,以血浆D-二聚体、AT-Ⅲ、PT、FIB作为自变量建立logistic回归模型,结果显示血浆D-二聚体、AT-Ⅲ、FIB是影响自然分娩产妇产后出血的影响因素(P<0.05),对产后出血具有较高的预测价值。结论:产前血浆D-二聚体、AT-Ⅲ和FIB水平对自然分娩产妇产后出血具有重要预测价值,临床上应密切监测该指标,避免发生产妇产后出血。

Objective: To explore the predictive value of plasma D-dimer, antithrombin-Ⅲ(AT-Ⅲ) and related coagulation four indices indicators for postpartum bleeding in natural delivery, and provide reference for the risk of natural delivery. Method: Retrospective analysis was made on the clinical data of 166 parturients with spontaneous delivery who were admitted to the Department of Obstetrics and Gynaecology of the Wuhan Jiangxia District First People’s Hospital from January 2020 to September 2021. According to whether there was postpartum hemorrhage after delivery, they were divided into two groups: bleeding group(n=86) and control group(n=80).Early morning venous blood was taken from the selected parturients at 32-37 weeks of pregnancy for detection of D-dimer, AT-Ⅲ and coagulation four indices indicators [prothrombin time(PT), thrombin time(TT), activated partial thromboplastin time(APTT), fibrinogen(FIB)]. Result: The level of plasma D-dimer expression in the bleeding group was significantly higher than that in the control group, while AT-Ⅲ was significantly lower than that in the control group, and the differences were statistically significant(P<0.05). There were no significant differences in TT and APTT between the two groups(P>0.05). The PT in the bleeding group was significantly longer than that in the control group, and the FIB was lower than that in the control group(P<0.05). The logistic regression model was established with the blood loss of the selected parturients as the dependent variable and the plasma D-dimer, AT-Ⅲ, PT, FIB as the independent variable. The results showed that plasma D-dimer, AT-Ⅲ, FIB were the influencing factors of postpartum hemorrhage in the parturients with natural delivery(P<0.05), which had high predictive value for postpartum hemorrhage. Conclusion: The prenatal plasma D-dimer, AT-Ⅲ and FIB levels have important predictive value for postpartum bleeding in natural pregnant women, which should be closely monitored to avoid postpartum bleeding.