妊娠期及产后母体D-二聚体的变化及临床意义

D-二聚体(D-dimer,DD)是交联纤维蛋白在纤溶酶降解下产生的纤维蛋白(原)降解产物(FDP)的一个片段,是诊断继发性纤溶亢进特异性较强的指标。妊娠期凝血与纤溶系统活性因子升高,血液处于高凝状态,纤维蛋白形成后纤溶也增加,因此DD也常用于产科,监测分娩前后母体凝血与纤维蛋白溶解的变化。临床常出现孕妇、产妇无明显原因的DD异常增高,甚至高达截断值的10倍以上[1]。妊娠期及产后DD究竟呈何变化,预测和诊断血栓、纤溶亢进是否真正具有价值,有待于进一步总结。     

不同妊娠结局的孕妇产前静脉血浆D-二聚体浓度变化及相关性研究

目的:初步探讨不同妊娠结局的孕妇产前外周静脉血浆D-二聚体(DD)浓度的变化。方法:422例不同妊娠结局的孕妇分为17组,比较各组产前母体DD浓度的差异;分析DD浓度与年龄、孕周、血细胞计数、凝血功能、肝脏功能等指标的相关性。结果:154例健康足月孕妇的DD浓度高于健康成人的截断值(P=0.002);妊娠并发DIC、双胎、死胎等3组患者的DD浓度无统计学差异(P=0.337),均高于健康足月孕妇(P=0.016,0.000,0.001);其余14组孕妇DD浓度无统计学差异(P=0.735)。DD与凝血功能(TT、PT、PTA、APTT)、孕周存在直线关系,与年龄、血细胞计数、肝脏功能等无直接相关,多元回归模型为DD=-11004.4+193.818TT+582.595PT+2009.9PTA+37.416APTT-36.363×(孕周),复相关系数为0.658,P=0.000。结论:产前母体DD基础水平升高,DD筛查产前凝血与纤溶异常需要新的截断值;妊娠并发DIC、双胎、死胎患者DD浓度进一步上升,需密切关注血液纤溶变化;DD浓度与凝血功能相关,产前血液高凝常伴随纤溶增强。     

肺炎心力衰竭患儿内皮素D-二聚体及纤维蛋白原变化的临床研究

目的研究婴幼儿肺炎并发不同程度心力衰竭时内皮素(ET)、D-二聚体(D-dimer)、纤维蛋白原(FBG)等变化及其内在联系，探讨该阶段血管内皮 功能、凝血、纤溶功能的变化。 方法选择2005-12—2006-08于邯郸市中心医院儿科就诊的肺炎及肺炎并发不同程度心力衰竭患儿80例作为观察组，健康婴幼儿20例作为对照组 ，均抽血检测ET、D-dimer、FBG、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)值。 结果各组间ET、D-dimer、FBG、APTT存在统计学差异，心衰程度越重，ET、D-dimer、FBG越高，APTT越低，其中以肺炎并发重度心衰组明显， ET与D-dimer间呈正相关(r=0.42,P<0.01)；D-dimer与FBG间也呈正相关(r=0.30,P<0.01)。 结论婴幼儿肺炎并发心力衰竭时存在内皮细胞功能紊乱和凝血、纤溶系统的激活。     

早孕期(8~12周)血清D-二聚体、纤维蛋白原和妊娠相关蛋白A单独与联合预测稽留流产的效能CSCD

目的 探讨早孕期血清D-二聚体(DD)、纤维蛋白原(Fib)以及妊娠相关蛋白A联合预测稽留流产的效能。方法 选取170例四川省广安市人民医院妇产科早孕期(8~12周)产妇为研究对象,比较不同妊娠结局产妇早孕期(8~12周)DD、Fib和妊娠相关蛋白A水平,分各项指标对稽留流产预测效能。结果 初次孕检时,稽留流产组和先兆流产组血清DD显著高于正常妊娠组,Fib和妊娠相关蛋白A显著低于正常妊娠组(P <0.05),其中妊娠相关蛋白A在稽留流产组中水平显著低于先兆流产组(P <0.05);血清DD、Fib和妊娠相关蛋白A预测稽留流产曲线下面积分别为0.761、0.828和0.721,三者联合预测曲线下面积为0.923,敏感度和特异度达91.72%和81.53%。结论 血清DD、Fib和妊娠相关蛋白A对稽留流产预测效能良好,联合检测可提高稽留流产的早期诊断率。     

早孕期（8~12周）血清D-二聚体、纤维蛋白原和妊娠相关蛋白A单独与联合预测稽留流产的效能#br#

Objective?To investigate the efficiencies of serum D-dimer (D-D), fibrinogen (Fib), pregnancy-associated plasma protein-A (PAPP-A) alone and in combination to predict missed abortion in early pregnancy (8~12 weeks). Methods?A total of 170 puerperae were selected as the research objects to compare the levels of DD, Fib and pregnancy-related protein A during the first trimester (8~12 weeks) of puerperae with different pregnancy outcomes. Results?During the first pregnancy examination, the serum DD in the missed abortion group and the threatened abortion group was significantly higher than that in the normal pregnancy group, and Fib and pregnancy-related protein A were significantly lower than those in the normal pregnancy group (P<0.05), significantly lower than the threatened abortion group (P<0.05). The areas under the curve of serum DD, Fib and pregnancy-related protein A for predicting missed abortion were 0.761, 0.828 and 0.721, respectively, and the combined prediction area of the three was 0.923, with sensitivity and specificity up to 91.72% and 81.53%. Conclusion?Combination of serum D-D, Fib and PAPP-A can improve the predictive efficiency and early diagnosis rate of missed abortion.     

凝血四项联合D-二聚体在孕妇产检中的应用研究

目的 探讨凝血四项联合D-二聚体在孕妇产检中的应用价值。方法 选取本院2000例产检孕妇为研究对象,以是否患有妊娠期糖尿病划分为研究组与对照组,回顾性分析两组孕妇、不同孕期以及分娩前后的凝血四项与D-二聚体指标变化情况。结果 研究组凝血酶原时间、活化部分凝血活酶时间、凝血酶时间短于对照组,纤维蛋白原、D-二聚体水平高于对照组,差异有统计学意义（P<0.05）;孕早期凝血酶原时间、活化部分凝血活酶时间、凝血酶时间短于孕中晚期,纤维蛋白原、D-二聚体水平低于孕中晚期,差异有统计学意义（P<0.05）;分娩后凝血酶原时间短于分娩前,活化部分凝血活酶时间、凝血酶时间长于分娩前,纤维蛋白原、D-二聚体水平低于分娩前,差异有统计学意义（P<0.05）。结论 凝血四项联合D-二聚体对于预测和检测妊娠期糖尿病孕妇的凝血状态具有重要临床意义,值得推广。     

原发性纤维蛋白溶解症二例临床分析

本研究通过报告2例直系亲姐妹,均属于先天性原发性纤维蛋白溶解症,时隔4个月,先后于我院剖宫产分娩的不同结局,加强对原发性纤维蛋白溶解症的认识。本研究例1是妹妹,因对原发性纤维蛋白溶解症认识不够,造成产后出血,行子宫次全切除术。鉴于其妹妹的经验教训,例2（姐姐）术中输纤维蛋白原4 g,输血浆400 mL,术后即刻予静脉滴注氨基己酸1 g/h,维持至术后12 h,诊疗成功。抗纤维蛋白溶解治疗是目前治疗先天性纤维蛋白溶解症的唯一有效的方法。常用纤维蛋白溶解抑制剂有氨基己酸、氨甲环酸和氨甲苯酸。氨基己酸,首次静脉注射4～6 g,溶于100 mL生理盐水或5%葡萄糖溶液内静脉滴注,15～30 min滴完。以后0.5～1 g/h静脉滴注维持,可持续8～24 h,直至症状得到控制。在使用纤维蛋白溶解抑制剂的基础上可输入冻干人纤维蛋白原或新鲜血浆,合并出血者可输新鲜血。     

重庆地区妊娠期妇女不同孕周血浆D-二聚体水平变化的研究

目的:观察重庆地区健康单胎孕妇的血浆D-二聚体水平变化,并建立重庆地区孕妇不同孕周的血浆D-二聚体水平及参考区间,以指导孕期管理.方法:纳入2020年3月至2020年9月在重庆医科大学附属第一医院进行常规产前检查的无合并症及并发症的健康单胎孕妇5052例,于清晨空腹采集枸橼酸钠抗凝静脉血3ml,分离血浆检测D-二聚体水...     

产科急性DIC22例的临床诊治分析

产科弥散性血管内凝血(d issem inated intravascu lar coag-u lation,D IC)是产科严重的并发症,发病急骤,病情复杂且凶险,是引起母婴死亡的重要原因之一。近年,我们根据其病理特点及临床表现,在救治中重视了纤维蛋白原的应用,取得了满意的疗效,现报道如下。1资料与方法1.1一般     

妊娠期及产褥期血浆D-二聚体的变化及意义

目的:探讨妊娠期及产褥期血浆D-二聚体(D-D)的变化特点,初步制定正常孕产妇血浆D-D的参考值范围,并探讨妊娠及分娩相关因素(分娩年龄、肥胖、分娩方式)对血浆D-D水平的影响.方法:收集2020年3月至2021年10月在四川大学华西第二医院定期产前检查、分娩及产后42天随访的孕产妇,最终纳入292例正常单胎孕产妇进行...     

Longitudinal assessment of D-dimer and plasminogen activator inhibitor type-1 plasma levels in pregnant women with risk factors for preeclampsia

Objective: Investigating D-Dimer/D-Di and plasminogen activator inhibitor type-1/PAI-1 levels throughout gestation in women with preeclampsia/PE risk factors.

Methods: D-Di and PAI-1 plasma levels were determined in 28 women at 12–19, 20–29, 30–34 and 35–40 weeks of gestation.

Results: D-Di was lower at 12–19 weeks and higher at 30–34 weeks in women who developed PE versus who did not develop it. D-Di increased throughout gestation in both groups, peaking earlier in pregnant women who developed PE versus who did not develop it. PA1-1 increased across gestation, but it didn’t differ between groups.

Conclusion: D-Di was able to discriminate these groups of women at 12–19 and 30–34 weeks of gestation.     

中重度妊高征患者血浆NO ET MDA水平及SOD活性变化及其临床意义

目的　探讨NO、ET和脂质过氧化在妊高征中的作用。方法　对 2 3例中、重度妊高征患者血浆中NO的稳定代谢产物亚硝酸盐 /硝酸盐 (NO-2 /NO-3)、ET 1、MDA水平及SOD活性进行测定。结果　中、重度妊高征组与正常晚期妊娠组比较 ,各指标均有显著性差异 (P <0 0 1) ;妊高征患者NO/ET值与SOD/MDA值呈显著正相关 (r =0 895 0 ,P <0 0 1) ;而MAP与NO/ET值呈显著负相关 (r =- 0 844 7,P <0 0 1)。结论　妊高征发生可能与脂质过氧化损伤所引起的NO/ET比例失调有关     

Factors associated with poorer childbirth outcomes in pregnant women diagnosed with placenta previa

ObjectivePlacenta previa is a health issue during pregnancy when the placenta wholly or partially covers the opening of the uterus. It can result in bleeding during pregnancy or after delivery, and preterm delivery. This study aimed to investigate the risk factors correlated with poorer childbirth outcomes of placenta previa.Materials and methodsBetween May 2019 and January 2021, pregnant women diagnosed with placenta previa in our hospital were enrolled. Outcomes were postpartum hemorrhage after childbirth, and lower Apgar score and preterm delivery of the neonate. Laboratory blood examination data preoperatively were collected from medical records.ResultsA total of 131 subjects were included, with a median age 31 years. Multivariate analysis showed that fibrinogen reduced risk for postpartum hemorrhage (adjusted odds ratio (aOR): 0.45, 95% confidence interval (CI): 0.26–0.79, p = 0.005). Homocysteine (aOR: 0.73, 95% CI: 0.54–0.99, p = 0.04) reduced the risk while D-dimer (aOR: 1.19, 95% CI: 1.02–1.37, p = 0.02) increased the risk for low Apgar score. Age (aOR: 0.86, 95% CI: 0.77–0.96, p = 0.005) decreased the risk but history of full-term pregnancy more than twice (aOR: 8.58, 95% CI: 2.32–31.71, p = 0.001) increased the risk for preterm delivery.ConclusionThe findings suggest that poorer childbirth outcomes in pregnant women with placenta previa are associated with young age, history of full-term pregnancy, and preoperative concentrations of low fibrinogen, low homocysteine and high D-dimer. This provides obstetricians adjunctive information for early screening of high-risk population and relevant treatment arrangement in advance.     

儿童重症肺炎支原体肺炎中D-二聚体水平的临床意义

目的 分析D-二聚体(D-D)水平对判断儿童肺炎支原体肺炎(MPP)病情严重程度的临床价值及对重症MPP(SMPP)早期识别的意义.方法 选取2018年8月至2020年12月于包头市第四医院儿科住院部收治的MPP患儿255例,其中包含SMPP患儿80例(SMPP组)及非SMPP患儿175例(非SMPP组).观察比较SM...     

Plasma D-dimer level in the diagnosis of adnexal torsion

Objective: To date, there is no clinical or laboratory examination particular to adnexal torsion (AT); therefore, the objective of this study was to evaluate whether the plasma D-dimer level has any merit in establishing a diagnosis in AT patients.

Materials and methods: In total, 34 women who underwent laparoscopic surgery due to adnexal mass were incorporated into our study. While the study group consisted of 14 women operated on due to AT, the control group comprised of 20 patients operated on due to benign ovarian cysts. In order to study the plasma D-dimer level during the pre-operative period, venous blood samples were obtained from all the women who participated in this study.

Results: The plasma D-dimer level in the AT group was seen to be significantly higher than that of the control group (2.20?±?1.71?µg/ml, 0.43?±?0.21?µg/ml, p?=?0.002, respectively). When the cut-off value for the D-dimer level was taken as 0.65?µg/ml, the sensitivity in determining the AT was found to be 71.4%, whereas the specificity was 85%.

Conclusions: The results obtained from our present study suggest that the plasma D-dimer level could be a supplementary laboratory examination in establishing diagnoses in AT patients.     

几种易栓症孕产妇凝血功能的变化及意义

目的 观察几种易栓症(thrombophilia)孕产妇凝血功能的变化及意义.方法 2006年9月至2007年12月对南方医科大学南方医院85例易栓症孕产妇和30例正常孕产妇分娩前后的P-选择素、凝血酶原片段1 2(F1 2)、D-二聚体(DD)、纤溶酶抗纤溶酶复合物(PAP)的含量和抗凝血酶活性(AT-Ⅲα)进行检测.结果 病例组中P-选择素、F1 2、DD、PAP水平分娩前均明显增高(P＜0.05);分娩后子(癎)前期重度组P-选择素水平明显高于正常妊娠组(P＜0.05);AT-Ⅲα在妊娠合并系统性红斑狼疮(SLE)、子(癎)前期组中与正常妊娠组比较分娩前后均有降低(P＜0.05);妊娠合并糖尿病组AT-Ⅲα与正常妊娠组比较,差异无统计学意义(P＞0.05).结论 P-选择素、F1 2、DD、AT-Ⅲα可作为易栓症孕产妇的临床监测指标.     

妊娠期妇女糖耐量胰岛素 胰岛素抵抗变化规律的观察

目的：观察不同孕期孕妇的糖耐量、胰岛素释放、胰岛素抵抗，以了解妊娠期糖代谢变化的规律。方法：对早、中、晚孕期三组共１２４例正常孕妇及２３例健康非孕妇女作为对照组进行７５ｇ口服糖耐量试验（ＯＧＴＴ）。其中１３例自早孕期开始纵向跟踪。以胰岛素曲线下面积与血糖曲线下面积的比值反映胰岛素抵抗（ＩＳＲ）。结果：各个孕期的空腹血糖无明显差异，但均显著低于非孕期（Ｐ＜００５），服糖后血糖、胰岛素释放、胰岛素抵抗均随孕期延长逐渐上升。于中孕期开始出现显著性改变，至晚孕期进一步加重均显著高于孕早期（Ｐ＜００５）。结论：中孕期是妊娠期糖代谢开始出现根本性变化的时期，于此期对孕妇进行血糖监测，有助于妊娠期糖尿病（ＧＤＭ）的早期诊断。晚孕期是ＧＤＭ最容易发生的时期