【摘要】 目的探讨外周血D-二聚体(D-D)对妊娠期和产褥早期女性发生血栓栓塞性疾病的影响,并分析两个时期外周血D-D水平的变化趋势。方法选取2015年1月-2016年7月在上海市嘉定区妇幼保健院足月分娩的健康单胎孕妇4 000例,产后发生下肢静脉血栓栓塞或肠系膜静脉血栓栓塞产妇2例。将正常孕产妇根据孕周分为:早孕组(<12周)、中孕组(12~28周)、晚孕组(>28周)、产褥期A组(≤24 h)、产褥期B组(25~48 h),每组各800例,检测各组血浆D-D、D-D 95%CI的水平。结果外周血D-D与孕程相关:中孕组、晚孕组和产褥期各组女性外周血D-D水平均高于早孕组,组间比较差异有统计学意义(均P<0.05);产褥期B组D-D水平下降,显著低于晚孕组及产褥期A组,差异有统计学意义(均P<0.05)。外周血D-D与分娩方式相关:产褥期A组和B组中阴道分娩者外周血D-D水平低于剖宫产分娩者,产褥期A组差异有统计学意义(P<0.05)。外周血D-D水平与血栓栓塞疾病相关:栓塞组的外周血D-D水平显著高于健康女性,产褥期A组差异有统计学意义(P<0.05)。结论外周血D-D水平不具有稳定性,临床上不宜作为筛查血栓栓塞性疾病的指标。更多还原

【Abstract】 Objective To explore the effects of D-dimer levels in peripheral blood on thrombosis diseases in women during pregnancy and early puerperium,analyze the variation trends of D-dimer levels in peripheral blood during pregnancy and early puerperium.Methods A total of 4 000 healthy and pregnant women of full-term single birth were selected from Maternal and Child Health Care Hospital of Jiading District from January 2015 to July 2016,then two postpartum women were diagnosed as deep vein thrombosis or mesenteric venous thrombosis. The normal pregnant women were divided into early pregnancy group( <12 weeks),middle pregnancy group( 12-28 weeks),late pregnancy group( >28 weeks),puerperium A group( ≤24 hours),and puerperium B group( 25-48 hours) according to gestational week,800 women in each group. The levels of D-dimer and D-dimer 95% CI in the five groups were detected. Results The levels of Ddimer in peripheral blood were correlated with gestational weeks. The levels of D-dimer in peripheral blood in middle pregnancy group,late pregnancy group,puerperium A group,and puerperium B group were statistically significantly higher than that in early pregnancy group( all P<0. 05). The level of D-dimer in peripheral blood in puerperium B group decreased,which was statistically significantly lower than those in late pregnancy group and puerperium A group( both P<0. 05). The levels of D-dimer in peripheral blood were correlated with delivery modes. In puerperium A group and puerperium B group,the levels of D-dimer in peripheral blood of women undergoing vaginal delivery were lower than those undergoing cesarean section,and there was statistically significant difference in puerperium A group( P<0. 05). The levels of D-dimer in peripheral blood were correlated with thrombosis diseases. The level of D-dimer in peripheral blood of women with thrombosis diseases was higher than that of healthy women,and there was statistically significant difference in puerperium A group( P <0. 05). Conclusion The levels of D-dimer in peripheral blood are not stable,so it shouldn’t be recommended as a clinical screening index of thrombosis diseases.更多还原