孕妇产前凝血功能分析及D-二聚体参考区间构建

Analysis of Coagulation Parameter and Establishment of D-dimer Reference in Pregnant Women

目的分析以厦门为代表的闽南地区妊娠期妇女在产前的不同时期凝血功能[包括凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,FIB)、凝血酶时间(thrombin time,TT)]和D-二聚体(D-dimer,D-D)检测结果变化,建立妊娠早、中、晚及临产期D-D的参考区间。方法本研究选取2021年6月—2022年5月于厦门大学附属妇女儿童医院进行产前检查6592名妊娠期女性作为观察组(孕早期组:n=99;孕中期组:n=2337;孕晚期组:n=906;临产组:n=3250);同期在院内体检的514名非妊娠健康妇女作为对照组,回顾性分析PT、APTT、FIB、TT以及D-D检测结果,构建妊娠各期D-D的参考区间。结果孕妇PT、APTT、TT伴随妊娠进程逐渐缩短,而FIB和D-D逐渐升高。在孕早期,PT、APTT较非妊娠组有缩短趋势,D-D较非妊娠组有升高趋势,差异无统计学意义(P>0.05)。至妊娠中期,各凝血参数与对照组相比较,差异具有统计学意义(P<0.05)。D-D在孕早期、中期、晚期及临产期的参考区间分别为21.7~657.5 ng/mL、498.7~641.9 ng/mL、908.3~1208.1 ng/mL、1353.8~1616.0 ng/mL。结论文章分析了以厦门为代表的闽南沿海地区妊娠妇女在不同孕期其凝血参数水平的变化,并建立了D-D在妊娠各期的参考区间,研究结果为临床医生更准确地监测孕妇凝血和纤溶状态提供重要参考。

Objective To analyze the changes in coagulation function[including prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),thrombin time(TT)]and D-dimer(D-D)test results of pregnant women in different pregnancy stages,and to preliminarily establish the reference interval of D-D in early,middle and late pregnancy and labor.Methods A total of 6592 pregnant women who underwent prenatal examinations at the Women and Children's Hospital Affiliated to Xiamen University from June 2021 to May 2022 were selected as the observation group(early pregnancy group:n=99;mid pregnancy group:n=2337;late pregnancy group:n=906;labor group:n=3250);The 514 non pregnant healthy women who were examined in the hospital during the same period served as a control group(non pregnant healthy women:n=514).The results of PT,APTT,FIB,TT,and D-D tests were retrospectively analyzed.The reference interval was calculated for D-dimer.Results With the increase of pregnancy progress,PT,APTT and TT of pregnant women gradually shortened,while FIB and D-D gradually increased.In the first trimester,PT and APTT tended to be shorter than those of the nonpregnant group,and D-D was higher than that of the non-pregnant group,but the differences were not statistically significant(P>0.05).In the second trimester,compared with the non-pregnant control group,the difference was statistically significant(P<0.05).The reference intervals of D-D in early pregnancy,middle,late and labor are 21.7-657.5 ng/mL,498.7-641.9 ng/mL,908.3-1208.1 ng/mL,and 1353.8-1616.0 ng/mL,respectively.Conclusion In this article,the changes of coagulation parameter in different pregnancy trimesters were observed,and the reference interval of D-D was presented,which may provide some reference for clinicians to more accurately monitor the coagulation and fibrinolysis status in pregnant women.