吴迪,龚晨,兰晶,郭晗,杨静,杨硕,魏媛,乔蕊.胎盘早剥产妇妊娠期止血功能变化特征及其预测产后出血的价值[J].临床检验杂志,2019,(9):661-665
胎盘早剥产妇妊娠期止血功能变化特征及其预测产后出血的价值
Hemostatic function change during pregnancy of women with placental abruption and its application for predicting postpartum hemorrhage
投稿时间:2019-06-12  
DOI:
中文关键词:  胎盘早剥  妊娠期糖尿病  纤维蛋白原  产后出血
英文关键词:placental abruption  gestational diabetes mellitus  fibrinogen  post-partum hemorrhage
基金项目:国家自然科学基金(81601824);北京大学第三医院院临床重点项目(BYSY2017008)
作者单位
吴迪 北京大学第三医院检验科北京100191 
龚晨 北京大学第三医院妇产科北京100191 
兰晶 北京大学第三医院检验科北京100191 
郭晗 北京大学第三医院检验科北京100191 
杨静 北京大学第三医院妇产科北京100191 
杨硕 北京大学第三医院检验科北京100191 
魏媛 北京大学第三医院妇产科北京100191 
乔蕊 北京大学第三医院检验科北京100191 
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中文摘要:
      摘要:目的:研究发生胎盘早剥的孕妇在妊娠期止血功能的改变与正常妊娠是否有差异,以及临产前止血功能检测是否有助于产后出血的预测和判断。方法:连续入选2013年12月1日至2018年12月1日在北京大学第三医院分娩诊断为胎盘早剥的孕妇,同时根据年龄和孕周匹配健康妊娠孕妇和妊娠期糖尿病孕妇作为对照。收集入选产妇的临床资料、产后结局及怀孕至分娩期间所有止血功能检查结果等数据并分析。结果:连续入选胎盘早剥产妇152例,健康妊娠产妇268例、妊娠期糖尿病产妇101例。正常妊娠过程中,随着妊娠周数增加,PT、APTT和TT都逐渐缩短,Fib、FDP和DD都逐渐升高;妊娠期糖尿病组表现类似变化趋势;而在胎盘早剥组中,Fib(g/L)在妊娠中期后表现下降的趋势,在临产时低于健康妊娠组(4.11±0.17 vs 4.35 ± 0.07 ,P=0.011)。胎盘早剥孕妇无论是否合并妊娠期糖尿病,临产前Fib(g/L)在产后出血组和非出血组差异均有统计学意义(3.41±1.29 vs 4.30±0.94,P=0.001);ROC分析显示,临产时Fib判断胎盘早剥孕妇发生产后出血的AUC=0.703(95%置信区间为0.596~0.810),取截断值为4.00 g/L,阴性预测值为0.883。结论:胎盘早剥孕妇Fib水平不像正常孕妇和妊娠期糖尿病孕妇一样随妊娠周数升高,临产时检测Fib水平应有助于判断胎盘早剥孕妇是否发生产后出血。
英文摘要:
      Abstract: Objectives: To investigate whether the changes of hemostatic system in pregnant women with placental abruption are different from the pattern of the pregnant women without complications, and the tests of hemostatic function before labor are helpful for prediction and estimation of postpartum hemorrhage. Methods: The pregnant women diagnosed with placental abruption who delivered at Peking University Third Hospital from December 1st, 2013 to December 1st, 2018 were enrolled. The normal pregnant women with matched age and gestational weeks and the women complicated with gestational diabetes mellitus (GDM) were also involved in our study as controls. Their medical records, pregnancy outcomes and all the results of hemostatic tests were completely collected and analysed. Results: A total of 152 pregnant women with placental abruption, 268 normal pregnant women and 101 pregnant women with gestational diabetes mellitus were included. The hemostatic system in uncomplicated women and the women with GDM shared a similar course of changes, during which time PT, APTT and TT dropped, while Fib (fibrinogen), FDP and DD grew with increasing gestational weeks. However, in the women with placental abruption, Fib(g/L) presented downward trend in the second trimester and were significantly lower than the uncomplicated women at the same pregnancy period (4.11±0.17 vs 4.35±0.07, P=0.011). The Fib(g/L) levels in the women at delivery with placental abruption, whether complicated with GDM or not, showed significant difference between the women with and without postpartum hemorrhage (3.41±1.29 vs 4.30±0.94, P=0.001). According to the receiver operating charctistic curve, the area under the curve of Fib was 0.703 (95% confidence interval: 0.596-0.810) with cutoff value of 4.00 g/L and negative predictive value of 0.883. Conclusions: The fibrinogen level in pregnant women with placental abruption did not increase with gestational weeks as it was in uncomplicated women and the women with GDM. Fib level at the time of delivery may contribute to predict the occurrence of postpartum hemorrhage in the women with placental abruption.
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