妊娠期高血压疾病以及正常妊娠母体血浆D-二聚体浓度前瞻性研究

目的:研究正常妊娠以及妊娠期高血压疾病母体血浆D-二聚体(D-dimer,D-D)浓度随妊娠发展的变化趋势。方法:采用前瞻性研究方法,对180例妊娠前血压正常的孕妇,应用酶联免疫吸附试验(ELISA)的方法,检测母体血浆D-D在妊娠10～14、20～24、30～34周的水平,观察孕妇孕期变化并随访妊娠结局;同时选取50例血压正常未孕妇女作为对照。结果:①180例妊娠妇女,12例发生妊娠期高血压、10例子痫前期(4例重度、6例轻度)、158例孕妇妊娠结局正常。②正常妊娠后,母体血浆D-D浓度在妊娠10～14周高于正常未孕妇女,差异有显著统计学意义(P=0.000);妊娠10～14、20～24、30～34周,随孕周增加,母体血浆D-D浓度逐渐上升,差异均有统计学意义(P均=0.000)。③子痫前期、妊娠期高血压、正常妊娠妇女母体血浆D-D浓度在妊娠10～14、20～24、30～34周进行比较均无明显差异(P均>0.05)。结论:正常妊娠母体血浆D-D随着妊娠进展浓度逐渐增加,但妊娠期高血压疾病患者血栓倾向出现前其浓度变化不大,不宜作为疾病早期预测指标。

Perspective study on the levels of maternal D-dimer in women with hypertensive disorder complicating pregnancy and healthy pregnant women

Objective:To study the changes of maternal D-dimer(D-D) levels in women with hypertensive disorder complicating pregnancy and healthy pregnant women with the development of pregnancy.Methods:The levels of maternal D-D in 180 pregnant women with normal blood pressure previously and 50 unpregnant women with normal blood pressure were detected by enzyme-linked immunoassay technique during 10~14,20~24 and 30~34 gestational weeks.The pregnant outcomes were followed up.Results:①Among 180 pregnant women,12 cases were found gestational hypertension(gestational hypertension group),10 cases were found preeclampsia(6 cases of severe preeclampsia and 4 cases of mild preeclampsia,preeclampsia group) and 158 cases were found normal pregnant outcome(normal pregnant group).②The level of D-D in pregnant women during 10~14 gestational weeks was significantly higher than that in healthy unpregnant women(P=0.000);with the development of pregnancy,there was significant difference in the levels of maternal D-D between 10~14,20~24 and 30~34 gestational weeks(P=0.000).③At the same stages of 10~14,20~24,30~34 gestational weeks,there was no significant difference in the maternal levels of D-D between gestational hypertension group,preeclampsia group and normal pregnant group(P>0.05,respectively).Conclusion:The level of D-D increases with the development of pregnancy,but don't change dramaticly before thrombophilia,which isn't predictive index for hypertensive disorder complicating pregnancy.