妊娠期糖尿病女性孕晚期凝血功能指标与产后出血的相关性

Correlation between coagulation function and postpartum bleeding in pregnant women with diabetes

目的探讨孕晚期凝血功能指标对妊娠期糖尿病(GDM)产后出血的预测价值及与相关性。方法选取120例GDM孕妇作为研究对象,根据是否并发产后出血分为观察组(发生产后出血,n=24)和对照组(未发生产后出血,n=96)。对比2组孕晚期凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)和D-二聚体(D-D)差异,绘制受试者工作特征曲线(ROC)分析以上各指标及联合指标对GDM产后出血的预测价值,采用Pearson法分析PT、APTT、TT和D-D与产后出血量的相关性。结果与对照组比较,观察组血浆PT、APTT和TT均延长,FIB减少,D-D增多,差异均有统计学意义(均有P<0.05)。绘制ROC曲线分析得知,血浆PT、APTT、TT、FIB和D-D均可预测GDM产后出血,尤以五者联合效能最佳,其曲线下面积(AUC)(95%CI)为0.907(0.838,0.968),灵敏度和特异度分别为85.5%和92.4%。Pearson相关分析得知,血浆PT、APTT、TT和D-D与GDM产后出血量呈明显正相关(r值分别为0.745、0.759、0.774和0.789,P<0.001),而血浆FIB则与GDM产后出血量呈明显负相关(r值为-0.784,P<0.001)。结论GDM产后出血女性孕晚期血浆PT、APTT、TT、FIB和D-D异常表达,以上指标均与产后出血量呈明显相关,五者联合可有效预测GDM产后出血,值得推广。

Objective To explore the predictive value and the correlation of late pregnancy coagulation function indicators in postpartum hemorrhage of gestational diabetes mellitus(GDM).Methods One hundred and twenty pregnant women with GDM were selected as the research subjects,they were divided into the observation group(postpartum hemorrhage,n=24)and the control group(no postpartum hemorrhage,n=96)based on the presence postpartum hemorrhage.Prothrombin time(PT),activated partial thrombin time(APTT),thrombin time(TT),fibrinogen(FIB)and D-dimer(D-D)were compared between the two groups in late pregnancy.The receiver operating curve(ROC)was drawn to analyze the predictive value of the above indicators and combined indicators for postpartum hemorrhage in GDM.The Pearson method was used to analyze the correlation between PT,APTT,TT and D-D and the volume of postpartum hemorrhage.Results Compared with the control group,the observation group showed prolonged PT,APTT and TT,decreased FIB,and increased D-D,the differences were statistically significant(all P<0.05).The ROC curve analysis showed that plasma PT,APTT,TT,FIB,and D-D can all predict postpartum hemorrhage in GDM,with the best combined efficacy of the five.The area under the curve was 0.907(0.838,0.968),and the sensitivity and specificity were 85.5%and 92.4%,respectively.The Pearson correlation analysis showed that plasma PT,APTT,TT and D-D were significantly positively correlated with the amount of postpartum hemorrhage in GDM(r values were 0.745,0.759,0.774 and 0.789 respectively,P<0.001)while plasma FIB was significantly negatively correlated with the amount of postpartum hemorrhage in GDM(r values were-0.784,P<0.001).Conclusion In GDM patients with postpartum hemorrhage,abnormalities in plasma PT,APTT,TT,FIB,and D-D levels in late pregnancy are observed.These indicators are significantly correlated with the volume of postpartum hemorrhage.The combination of these five indicators can effectively predict postpartum hemorrhage in GDM,suggesting potential for clinical application.