妊娠期糖尿病患者血浆FM,D-Dimer和FIB检测评价不同治疗方案对凝血功能及不良妊娠结局的影响

Evaluate the Effects of Different Treatment Schemes on Coagulation Function and Adverse Pregnancy Outcomes with Fibrin Monomer,D-Dimer and FIB in Patients with Gestational Diabetes Mellitus

目的探讨纤维蛋白单体(FM)、D-二聚体(D-Dimer)以及纤维蛋白原定量(FIB)等凝血指标与妊娠期糖尿病(GDM)患者不同治疗方案和不良妊娠结局的关系。方法选取2021年6月~2022年1月在解放军总医院产科门诊就诊的正常孕晚期女性为正常妊娠组(n=40)和GDM患者(n=74),其中50例通过饮食和运动控制血糖(GDM非药物组),24例使用胰岛素控制血糖(GDM胰岛素组)。采用单因素方差分析和Kruskal-Wallis H检验比较三组患者研究指标的差异,采用LSD-t检验和Bonferroni校正进行两两比较;并观察不良妊娠结局患者凝血特征。结果正常妊娠组、GDM非药物组和GDM胰岛素组患者凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和凝血酶时间(TT)比较差异均无统计学意义(F=1.051,H=4.368,F=0.021,均P>0.05);FIB(4.24±0.66 g/L,4.57±0.71 g/L,4.22±0.58 g/L),D-Dimer[0.32(0.30,0.45)mg/L,0.49(0.32,0.73)mg/L,0.34(0.21,0.45)mg/L],FM[3.44(2.82,5.08)mg/L,4.53(3.44,12.99)mg/L,4.61(4.10,6.23)mg/L]比较,差异均有统计学意义(F=3.847,H=9.194,8.968,均P<0.05)。两两比较显示,正常妊娠组FIB和FM水平低于GDM非药物组(t=2.429,U=2.627,均P<0.05),GDM胰岛素组FIB和D-Dimer水平低于GDM非药物组(t=2.102,U=2.665,均P<0.05),差异均有统计学意义。正常妊娠组、GDM非药物组和GDM胰岛素组患者FM正常率(FM≤6.0 mg/L)分别为80.00%,60.00%和78.30%;高血栓发生风险率(FM≥35 mg/L)分别为7.50%,12.00%和4.17%;D-Dimer正常率(D-Dimer<0.23 mg/L)分别为12.50%,6.00%和20.83%。临床结局方面,出现不良妊娠结局患者FM和D-Dimer均高于血栓风险界值。结论FM,D-Dimer和FIB联合使用可有效反映GDM患者不同治疗方案下凝血功能的差异,具备预测不良妊娠事件的潜力,且FM作为孕期血栓风险标志物的临床价值优于D-Dimer。

Objective To explore the relationship between fibrin monomer(FM),D-Dimer,Fibrinogen(FIB)and othercoagulation index among different treatment schemes and adverse pregnancy outcomes in patients with Gestational Diabetes Mellitus(GDM).Methods From June 2021 to January 2022,a total of 114 women from the Obstetric Clinic of PLA General Hospital were selected as study subjects,including 40 women with normal pregnancy in the third trimester(normal pregnancy group),50 patients control their blood glucose through diet and exercise(GDM-non-drug group),and 24 patients control their blood glucose with insulin(GDM-insulin group).One-way ANOVA and Kruskal-Wallis H tests were used to compare the differences of research indicators among the three groups.Furthermore,LSD-t test and Bonferroni correction for pairwise comparison were counted.The coagulation characteristics of patients with adverse pregnancy outcomes were observed.Results There was no statistically significant difference in prothrombin time(PT),thrombin time(TT)and activated partial thromboplastin time(APTT)among the normal pregnancy group,GDM non-drug group and GDM insulin group(F=1.051,H=4.368,F=0.021,all P>0.05).However,FIB(4.24±0.66 g/L,4.57±0.71 g/L,4.22±0.58g/L),D-Dimer[0.32(0.30,0.45)mg/L,0.49(0.32,0.73)mg/L,0.34(0.21,0.45)mg/L]and FM[3.44(2.82,5.08)mg/L,4.53(3.44,12.99)mg/L,4.61(4.10,6.23)mg/L],the differences were statistically significant(F=3.847,H=9.194,8.968,all P<0.05).The pairwise comparison showed that FIB and FM in the normal pregnancy group were lower than those in the GDM-non-drug group(t=2.429,U=2.627,all P<0.05),FIB and DD in GDM-insulin group were lower than those in GDM-non-drug group(t=2.102,U=2.665,all P<0.05),and the differences were statistically significant,respectively.Among normal pregnancy group,GDM-non-drug group and GDMinsulin group,the rates of normal FM(FM≤6.0 mg/L)were 80.00%,60.00%and 78.30%,the high risk of thrombosis(FM≥35 mg/L)were 7.50%,12.00%and 4.17%,and the normal rates of D-Dimer(D-Dimer<0.23 mg/L)were 12.50%,6.00%and 20.83%,respectively.In terms of clinical outcomes,FM and D-Dimer displayed the higher levels than the respective thrombosis threshold values in patients with adverse pregnancy outcomes.Conclusion FM combined with D-Dimer and FIB could effectively reflect the difference of coagulation function of GDM patients under different treatment schemes,and has the potential to predict adverse pregnancy events.The clinical value of FM as a risk marker of pregnancy thrombosis is better than D-Dimer.