抗凝血酶和D-二聚体预测孕晚期妊娠并发症的价值

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英文篇名：Antithrombin and D-dimer in predicting pregnancy complications in the 3rd trimester of pregnancy 作者：李琴 ; 张驰 ; 费阳 ; 唐宁 英文作者：LI Qin;ZHANG Chi;FEI Yang;TANG Ning;Department of Clinical Laboratory,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology; 关键词：抗凝血酶 ; D-二聚体 ; 妊娠并发症 英文关键词：Antithrombin;;D-dimer;;Pregnancy complications 中文刊名：SHYY 英文刊名：Laboratory Medicine 机构：华中科技大学同济医学院附属同济医院检验科; 出版日期：2018-10-31 09:26 出版单位：检验医学 年：2018 期：v.33 语种：中文; 页：SHYY201810013 页数：4 CN：10 ISSN：31-1915/R 分类号：54-57

摘要

目的探讨抗凝血酶(AT)和D-二聚体(DD)对孕晚期妊娠并发症的预测价值。方法回顾性分析妊娠晚期孕妇,排除妊娠前即确诊患有原发性高血压、糖尿病、心脏病、慢性肾病、慢性肝病者以及因胎儿染色体异常、发育畸形终止妊娠者,共纳入5 095例孕妇。按照不同并发症对孕妇进行分组,比较有并发症者与无并发症者AT和DD结果的差异。采用Logistic回归分析评估AT、DD异常对各类妊娠并发症的预测价值。结果 5 095例孕妇中有606例在孕28～40周发生并发症,包括子痫前期353例、妊娠期肝内胆汁淤积(ICP)105例、妊娠期糖尿病88例、死胎45例、深静脉血栓形成(DVT)15例,有4548例未发生并发症。不同并发症孕妇DD水平均显著高于无并发症孕妇(P<0.05)。子痫前期孕妇AT水平显著低于无并发症孕妇,而ICP孕妇AT水平显著高于无并发症孕妇(P<0.05)。与无并发症孕妇相比,ICP、死胎孕妇年龄较小,而妊娠期糖尿病孕妇年龄较大(P<0.05)。AT>115%者发生ICP的比值比(OR)值为20.24[95%(CI)12.87～31.82];AT<70%者发生子痫前期的OR值为5.41(95%CI3.72～7.87);DD>3.98μg/mL者发生DVT的OR值为5.74(95%CI 2.03～16.20),发生死胎的OR值为4.05(95%CI 2.16～7.52),发生ICP的OR值为2.95(95%CI1.73～5.02),发生子痫前期的OR值为2.76(95%CI 2.01～3.81)。结论检测孕妇妊娠晚期DD和AT水平对于妊娠并发症有一定的预测价值。
        Objective To investigate the roles of antithrombin(AT) and D-dimer(DD) in predicting pregnancy complications in the 3 rd trimester of pregnancy. Methods A total of 5 095 pregnant women were enrolled. Women in the 3 rd trimester of pregnancy were included,while women with primary hypertension,diabetes mellitus,cardiac diseases,chronic nephrosis and chronic hepatopathy before pregnancy and women terminating pregnancy due to fetal chromosome abnormality were excluded. The levels of AT and DD in patients with and without pregnancy complications were compared,and Logistic regression analysis was used for evaluating the roles of AT and DD in predicting pregnancy complications. Results The maternal complications of 5 095 pregnant women during the 28 th-40 th gestational weeks in this study included 353 cases of preeclampsia,105 cases of intrahepatic cholestasis during pregnancy(ICP),88 cases of gestational diabetes mellitus,45 cases of stillbirth and 15 cases of deep vein thrombosis(DVT). There were 4 548 pregnant women without pregnancy complications. The level of DD in patients with pregnancy complications was higher than that without pregnancy complications(P<0.05). The level of AT in patients with preeclampsia was lower than that without pregnancy complications(P<0.05). The level of AT in patients with ICP was higher than that without pregnancy complications(P<0.05). Compared with pregnant women without pregnancy complications,patients with ICP and stillbirth were younger,while those with gestational diabetes mellitus were elder(P<0.05). The odds ratio(OR) of ICP for patients with AT>115% was 20.24 [95% confidence interval(CI)12.870-31.819]. The OR of preeclampsia for patients with AT<70% was 5.41(95%CI 3.72-7.87). The OR of DVT for patients with DD>3.98 μg/mL was 5.74(95%CI 2.03-16.20),that of stillbirth was 4.05(95%CI 2.16-7.52),that of ICP was 2.95(95%CI 1.73-5.02),and that of preeclampsia was 2.76(95%CI 2.01-3.81). Conclusions AT and DD can predict pregnancy complications in the 3 rd trimester of pregnancy.

引文

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