临产孕妇血浆D-二聚体水平对产后D IC的预测价值

摘要

目的：探讨血浆D-二聚体（D-D ）水平对产后出血所致弥漫性血管内凝血（D IC ）的预测价值。方法选择正常足月（孕周不低于37周）的临产孕妇156例作为临产组，并按分娩方式分为顺产组（ n＝102）和剖宫产组（ n＝44）。临产组中，将产后24 h内出血量大于500 mL的18例产妇作为产后出血组。选择12例DIC产妇作为DIC组，同期健康的非妊娠妇女92例作为对照组。检测产后24 h出血总量，采用STA-Compact全自动血凝分析仪检测血浆D-D质量浓度。血浆D-D对产后DIC的预测效能评价采用非参数受试者工作特征（ROC ）分析。结果血浆D-D质量浓度由低到高依次为对照组、临产组、产后出血组、DIC组，两两比较，差异有统计学意义（ P＜0．01）。顺产组与剖宫产组产妇血浆 D-D 质量浓度分别为1．12～1．81 m g/L （平均1．33 mg/L）、1．07～2．27 mg/L（平均1．37 mg/L），二者差异无统计学意义（P＞0．05）。对照组、临产组妇女血浆D-D质量浓度的95％参考范围分别为：＜0．45 mg/L（95％ CI：0．30～0．48）、＜2．75 mg/L（95％ CI：2．00～3．00）。临产组产妇产前血浆D-D质量浓度与产后出血量无明显相关性（r＝0．319，P＝0．170），而二者在产后出血组、DIC组产妇中呈中等相关（r分别为0．470、0．643， P分别为0．048、0．024）。产前血浆D-D质量浓度对产后DIC的预测效能显示，其 ROC曲线下面积（AUC）为0．849（95％ CI：0．715～0．983）；临界值不低于3．0 m g/L时，可获预测最佳敏感性（91．7％）及特异性（66．7％）。结论 D-D水平对产后出血所致DIC具有较好的预测价值，但应制定专门的参考范围。%Objective To investigate the predictive value of plasma D-dimer(D-D) level of pregnant women for postpartum hem-orrhage caused disseminated or diffuse intravascular coagulation (DIC) .Methods 156 pregnant women in labor with normal full term pregnancy(not less than 37 weeks of gestational period) were served as labor group which was subdivided into natural labor group(n=102) and caesarean section group (n= 44) according to the mode of delivery .In labor group ,18 puerperas suffering hemorrhage greater than 500 mL within 24 h postpartum were served as postpartum hemorrhage group and 12 puerperas with DIC as DIC group .92 healthy non-pregnant women in the corresponding period were served as control group .The total volume of 24 h postpartum hemorrhage was detected and the plasma D-D concentration was measured by STA-Compact Automatic Coagulation Analyzer .Non-parametric receiver operator characteristic (ROC) analysis was employed to evaluate the predictive performance of plasma D-D for postpartum DIC .Results Groups with plasma D-D from low to high concentration were the control group ,labor group ,postpartum hemorrhage group and DIC group ,successively ,and pairwise comparison showed the differences had statistical significance(P<0 .01) .The mass concentration of plasma D-D of puerperas in natural labor group and caesarean section group were 1 .12-1 .81 mg/L(average 1 .33 mg/L) and 1 .07-2 .27 mg/L(average 1 .37 mg/L) ,respectively ,showing no statistically signifi-cant difference(P>0 .05) .The 95% reference ranges of plasma D-D mass concentration of women in the control group and labor group were <0 .45 mg/L(95% CI:0 .30-0 .48) and <2 .75 mg/L(95% CI:2 .00-3 .00) ,respectively .In labor group ,the antenatal plasma D-D mass concentration showed no obviously correlation with the postpartum hemorrhage volume (r=0 .319 ,P=0 .170) , while they demonstrated medium correlation in postpartum hemorrhage group and DIC group (r=0 .470 ,0 .643 ,P=0 .048 ,0 .024 , respectively) .The ROC area under the curve(AUC) of prediction of antenatal plasma D-D mass concentration for postpartum DIC were 0 .849(95% CI:0 .715-0 .983) .When cut off value was not less than 3 .0 mg/L ,the best sensitivity (91 .7% ) and specificity (66 .7% ) were obtained .Conclusion D-D level has good predictive value for postpartum DIC ,however ,its specific reference range should be formulated .