正常孕妇血浆D-二聚体的检测与分析

目的探讨正常孕妇血浆D-二聚体的变化特点,建立本实验室正常孕妇血浆D-二聚体的参考区间。方法选取正常孕妇664例、非孕正常女性对照者100名(正常对照组),产后发生弥散性血管内凝血(DIC)或静脉血栓患者18例。将正常孕产妇按孕周分为5组:(1)孕20周(127例);(2)孕20~32周(86例);(3)孕32周至临产≥32周(191例);(4)产后第1天(130例);(5)产后第2天(130例)。采用SYSMEX CA7000全自动凝血仪检测所有正常孕妇及正常对照组血浆D-二聚体浓度,确定相应的参考区间。孕妇D-二聚体浓度呈偏态分布,采用百分位数(P95)表示参考区间的单侧上限。采用建立的参考区间评估18例产后发生DIC或静脉血栓孕产妇的D-二聚体水平,验证该参考区间的有效性。结果 D-二聚体随着妊娠期的延长逐渐升高,从20周开始至32周逐渐上升,32周以后升高幅度最大,孕20周组、孕20~32周组及孕≥32周组D-二聚体参考区间分别为1.54 mg/L、3.46 mg/L及4.96 mg/L;分娩过程中D-二聚体发生了大幅度的变化,产后第l天急剧升高,至产后第2天明显下降,基本恢复至妊娠末期水平。产后第1天及产后第2天参考区间分别为11.76 mg/L、5.87 mg/L。5组间D-二聚体水平差异有统计学意义(P0.001)。正常对照组和孕妇组D-二聚体浓度低于排除DVT临界值(0.5 mg/L)的比例分别为92.3%、55.1%、7.0%、1.0%、0.2%和0.7%。采用上述参考区间评估18例产后发生DIC或静脉血栓孕产妇的D-二聚体水平,均为阳性结果。结论初步建立本实验室正常孕妇血浆D-二聚体参考区间,妊娠中后期D-二聚体已不具备特异性,不能作为排除诊断依据。

Detection and analysis of plasma D-dimer in healthy pregnant women

Objective To investigate the change characteristics of plasma D-dimer in healthy pregnant women and establish the reference range. Methods A total of 664 healthy pregnant women and 100 healthy women without pregnancy as control group were enrolled, and there were 18 cases of disseminated intravaseular coagulation （DIC） or venous thrombosis after delivery-. They were classified into 5 groups, pregnancy 〈 20 weeks （ 127 cases） , pregnancy 20-32 weeks （86 cases）, pregnancy ≥32 weeks （191 cases）, the first postpartum day （130 cases） and the second postpartum day- （130 cases）. D-dimer concentration was determined by SYSMEX CA7000 automatic coagulation analyzer in order to identify- the reference range. Since D-dimer concentration showed non-normal distribution, the normal values were established by percentile （P95）. The results of the 18 cases of DIC or venous thrombosis were used to validate the established normal values. Results D-dimer concentration increased continually with pregnancy from 20 weeks to 32 weeks, especially after 32 weeks. The reference ranges were 〈 1. 54 rag/L, 〈 3.46 mg/L and 〈 4.96 mg/L for pregnancy 〈 20 weeks, 20-32 weeks and ≥ 32 weeks. D-dimer had a significant change during childbirth, and there was a sharp increasing in the first postpartum day- and a significant decline in the second postpartum day- recovering to the levels of late pregnancy, which the reference ranges were 〈 11.76 mg/L and 〈 5.87 rag/L, respectively. All groups had statistical significance for D-dimer concentration （P 〈 0. 001 ）. The percentages of D-dimer which were lower than conventional critical value to exclude DVT （0.5 mg/L）were 92.3 % , 55.1% , 7.0% , 1.0% , 0.2% and 0.7% in control group and 5 groups in pregnancy, respectively. All the 18 cases of DIC or venous thrombosis showed positive results by the above normal values. Conclusions By analyzing the change characteristics of D-dimer in healthy pregnant women, D-dimer reference ranges in healthy pregnant wo