目的 探讨死胎患者分娩前母体D-二聚体水平的变化.方法比较27例死胎患者和293例健康孕妇产前凝血与纤溶检验学指标的差异,分析死胎患者产前D-二聚体浓度与年龄、孕次、产次、孕周、血小板计数、凝血功能、肝脏功能等临床指标的相关性.结果死胎患者的产前母体D-二聚体水平[409(102～18 021)μg/L]高于健康孕妇[216(1O～850)μg/L](P=0.000),而凝血酶原时间、凝血酶原时间活动度、凝血酶原标准化比值、活化部分凝血酶原时间、纤维蛋白原含量、凝血酶凝结时间与健康孕妇比较无统计学差异(P＞0.05).死胎患者D-二聚体水平与年龄、孕次、产次、孕周、血小板计数、凝血功能(凝血酶原时间、凝血酶原时间活动度、凝血酶原标准化比值、活化部分凝血酶原时间、纤维蛋白原、凝血酶凝结时间)、肝脏功能(白蛋白、球蛋白、谷丙转氨酶、谷草转氨酶、碱性磷酸酶、胆碱酯酶、总胆红素)等18项指标均不相关(r分别为0.114、0.239、0.174、-0.182、-0.268、-0.160、0.267、0.006、-0.131、-0.204、-0.023、-0.277、-0.069、0.165、0.249、-0.041、-0.103、-0.016,P均＞0.05).结论死胎患者分娩前D-二聚体水平升高,母体血液不但呈高凝状态,继发性纤维蛋白溶解也增强.%Abstract Objective To investigate the antepartum variation of D-dimer in stillbirth patients. Methods We compared the indicators of coagulation and fibrinolysis between stillbirth pregnant women (n = 27) and normal pregnant women (n = 293), and analysed the correlation between antepartum D-dimer concentration and maternal age, gravidity, parity, gestational weeks,platelet count,coagulation function,liver function in stillbirth patients. Results D-dimer concentration in stillbirth pregnant women were higher than that in normal pregnant women (P = 0.000), and there was no statistical difference in prothrombin time, prothrombin time activity, international normalized ratio of prothrom-bin,activated partial thromboplastin time,fibrinogen.thrombin clotting time between the two groups (P> 0.05). In stillbirth pregnancy,D-dimer concentration was not correlated to maternal age,gravidity,parity,gestational weeks,platelet count,coagulation function and liver function (P > 0.05). Conclusion D-dimer level in stillbirth pregnant women was increased independently. Not only the antepartum maternal blood in stillbirth pregnancy was hypercoagulable,but also secondary fibrinolysis was enhanced.
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