血清D-二聚体表达水平对产后出血的预测价值

摘要

目的 分析血清D-二聚体表达水平对产后出血的预测价值.方法 回顾性分析2015年1月至2016年12月于广州市花都区妇幼保健院产科分娩的388例产妇的临床资料,均无妊娠期高血压疾病,其中顺产190例(顺产组),剖宫产198例(剖宫产组).比较两组产前血浆D-二聚体水平、产后出血发生率及产后出血量;绘制受试者工作特征(ROC)曲线,分析血清D-二聚体表达水平对产后出血的相关预测价值.结果 顺产组产妇产后出血率为2.63%,明显低于剖宫产组的12.12%,差异有统计学意义(P<0.05);顺产组产妇的出血量为(331.87±43.85)mL,明显少于剖宫产组的(460.12±43.44)mL,差异有统计学意义(P<0.05);顺产组和剖宫产组产妇产前D-二聚体水平分别为(1.48±0.77)mg/L和(1.51±0.62)mg/L,差异无统计学意义(P>0.05);顺产组产后出血者D-二聚体水平为(2.27±0.81)mg/L,明显高于产后未出血者的(1.09±0.766)mg/L,差异有统计学意义(P<0.05);剖宫产组产后出血者的D-二聚体水平为(2.32±0.76)mg/L,明显高于产后未出血者的(1.14±0.71)mg/L,差异有统计学意义(P<0.05);顺产组与剖宫产组产后出血和产后未出血者D-二聚体水平比较差异均无统计学意义(P>0.05);采用Logistic回归绘制血清D-二聚体水平的ROC曲线,敏感性为83.3%,特异性为76.8%,曲线下面积为0.800.结论 D-二聚体水平升高提示产后出血发生率较高,而且D-二聚体水平对出血量也具有一定的预测价值.%Objective To analyze the predictive value of serum D-dimer expression level on postpartum hemorrhage. Methods The clinical data of 388 cases with maternal delivery (with no gestational hypertension disease) in Department of Obstetrics, Guangzhou Huadu District Maternal and Child Health Hospital from January 2015 to December 2016 were reviewed retrospectively, incluuding 190 of natural birth (natural birth group), and 198 cases of cesarean section (cesarean section group). The levels of plasma D-dimer, the incidence of postpartum hemorrhage and amount of postpartum hemorrhage were compared between the two groups. The ROC curve was drawn to analyze the predictive value of serum D-dimer expression level on postpartum hemorrhage. Results The postpartum hemorrhage rate in natural birth group was 2.63%, which was significantly lower than 12.12%in cesarean section group (P<0.05). The amount of postpartum hemorrhage in natural birth group was (331.87 ± 43.85) mL, which was significantly less than (460.12 ± 43.44) mL in cesarean section group (P<0.05). The levels of prenatal D-dimer in natural birth group and cesarean section group were respectively (1.48±0.77) mg/L and (1.51±0.62) mg/L, with no statistically significant difference (P>0.05). In natural birth group, the level of D-dimer in patients with postpartum hemorrhage was (2.27±0.81) mg/L, which was significantly higher than (1.09 ± 0.766) mg/L in patients without postpartum hemorrhage (P<0.05). In cesarean section group, the level of D-dimer in patients with postpartum hemorrhage was (2.32±0.76) mg/L, which was significantly higher than (1.14 ± 0.71) in patients without postpartum hemorrhage (P<0.05). There were no significant differences in the d-dimer level of postpartum hemorrhage and without postpartum hemorrhage between the natural birth group and cesarean section group (P>0.05). Logistic regression was used to draw the ROC curve of serum D dipolymer level, and the sensitivity was 83.3%, and the specificity of 76.8%, with the area under the curve of 0.800. Conclusion The D-dimer level increase indicates that postpartum hemorrhage has higher incidence, and the level of D-dimer has certain predictive value for bleeding volume.