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目的探讨血浆D二聚体在预测子前期发病中的的价值。方法收集2013年6月至2014年12月间建卡产检并分娩的孕产妇资料共计13 285例,所有孕妇均定期产检,随访至产后3个月并收集相关资料。其中有10 623例为无妊娠合并症的正常孕产妇,作为正常对照组;有577例诊断为妊娠期高血压,作为妊娠期高血压组。291例为子前期患者,作为子前期组对象,其中214例为轻度子前期,77例为重度子前期。所有研究对象在孕32周~34周间进行血浆D-二聚体的检测,分析D-二聚体在预测子前期发病中的作用及其与不良妊娠结局的关系。结果经T检验表明,子前期组的D-二聚体水平高于妊娠期高血压组,而妊娠期高血压组高于对照组(P<0.01)。但在轻、重度子前期组间D-二聚体的表达差异无统计学意义(P=0.728)。通过Pearson双变量相关法研究D-二聚体水平与各妊娠结局间的关系,结果表明D-二聚体水平越高,产后出血量越大,早产和难产率也越高,而新生儿Apgar评分和出生体质量均越低。应用Logistics回归方程证实了孕晚期D-二聚体水平的升高可预测子前期的发病。并应用ROC曲线计算得出D-二聚体的预测界值为0.995 mg/L时,其预测敏感度为95.8%,相对危险度为7.35。结论D-二聚体可作为预测子前期发病的实验室指标,且其与各种不良妊娠结局均有相关性,D-二聚体预测子前期发病的界值为0.995 mg/L,其预测敏感度为95.8%,相对危险度为7.35。
Objective To investigate the value of plasma D-dimer in predicting the incidence of preeclampsia. Methods A total of 13 285 maternal samples collected during the card check-up and delivery period between June 2013 and December 2014 were collected. All pregnant women were regularly inspected and followed up to 3 months after delivery and the relevant data were collected. Among them, 10 623 cases of normal pregnant women without pregnancy complications as a normal control group; 577 cases diagnosed as gestational hypertension as gestational hypertension. 291 cases of preeclampsia patients, as the pre-sub-group of objects, of which 214 cases of mild preeclampsia, 77 cases of severe preeclampsia. All subjects were tested for plasma D-dimer between 32 and 34 weeks of gestation, and the role of D-dimer in predicting the incidence of preeclampsia and its association with adverse pregnancy outcomes were analyzed. Results T-test showed that the level of D-dimer in the premature baby group was higher than that in the gestational hypertension group, while the gestational hypertension group was higher than the control group (P <0.01). However, there was no significant difference in the expression of D-dimer between the light and severe preeclampsia groups (P = 0.728). Pearson bivariate correlation study of D-dimer levels and the relationship between pregnancy outcomes, the results showed that the higher the level of D-dimer, the greater the amount of postpartum hemorrhage, the higher the rate of premature delivery and dystocia, while neonatal Apgar Scores and birth weight are lower. Application Logistics regression equation confirmed that the third trimester of D-dimer levels rise can predict the incidence of preeclampsia. The prediction sensitivity of D-dimer was 0.995 mg / L when calculated by ROC curve. The predicted sensitivity was 95.8% and the relative risk was 7.35. Conclusion D-dimer can be used as a laboratory index for predicting the incidence of preeclampsia, and it has a correlation with various adverse pregnancy outcomes. The cutoff value of D-dimer predicting preeclampsia is 0.995 mg / L, The predictive sensitivity was 95.8% and the relative risk was 7.35.