不同妊娠期正常孕妇及产科早期DIC患者PT、APTT、TT、FIB、D-D、FM变化的探讨

目的研究正常孕妇妊娠各期及产科早期弥漫性血管内凝血（DIC）患者凝血酶原时间（PT）、部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白（FIB）、D-二聚体（D-D）及纤维蛋白单体（FM）水平的变化。方法分别检测30例正常对照组妇女、90例正常妊娠妇女（妊娠早期30例、妊娠中期30例、妊娠晚期30例）及10例产科早期DIC患者的PT、APTT、TT、FIB、D-D及FM水平。结果正常孕妇组妊娠早期的PT及妊娠中、晚期的APTT、TT、FIB、FM与正常对照组比较,差异均有统计学意义（P〈0.001）;正常孕妇组妊娠各期D-D水平均高于正常对照组（P〈0.001）。产科早期DIC组与正常孕妇组妊娠各期及正常对照组比较,各项指标均有差异（P〈0.001）。正常孕妇组妊娠中、晚期PT、APTT较妊娠早期明显缩短（P〈0.001）,FM水平明显升高（P〈0.001）;TT、FIB、D-D水平在正常孕妇组妊娠各期中均有差异（P〈0.05、P〈0.001）。结论妊娠不同期,正常孕妇凝血机制会发生改变。一旦有早期DIC的发生FM水平会有较明显的升高,因此,FM指标的检测相对于D-D检测在确定早期DIC有着较明确的标识。对发现早期凝血异常有一定的帮助。

Research on the changes of PT,APTT,TT,FIB,D-D and FM parameters in different gestational pregnant women and patients with early DIC

Objective To research on the changes of the prothrombin time（PT）,activation part thrombin time（APTT）,thrombin time（TT）,fibrinogen（FIB）,D-dimer（D-D） and fibrin monomer（FM） parameters in healthy pregnant women and patients with different gestational and early disseminated intravascular coagulation（DIC）.Methods 30 healthy women,90 healthy pregnant women（30 cases in early phase,30 cases in middle phase and 30 cases in late phase pregnancy） and 10 patients with early DIC were enrolled.Their PT,APTT,TT,FIB,D-D and FM were detected.Results Compared with the healthy women,PT in the early phase pregnancy and APTT,TT,FIB and FM in the middle and late phase pregnancy among healthy pregnant women were significantly different（P0.001）.The level of D-D in healthy pregnant women was higher than that in healthy women（P0.001）.Compared with healthy pregnant women and healthy women,PT,APTT,TT,FIB,D-D and FM had significant difference in patients with early DIC（P0.001）.In healthy pregnant women,the levels of PT and APTT in middle and late phase pregnancy were shortened compared with that in early phase pregnancy（P0.001）,and the FM level was increased（P0.001）.There were significant difference in TT,FIB and D-D levels between different gestational pregnant women（P0.05,P0.001）.Conclusions In different gestational pregnancy,the normal blood coagulation mechanism will change.Once the early DIC has happened,the concentration of FM has more apparent increasing.FM may be a more obvious parameter than D-D in determining the early DIC.It is helpful for determining coagulopathy.