王爽 趙勁松 齊川 李滿(mǎn)元

單胎孕婦與多胎孕婦血漿D-二聚體水平比較

王爽 趙勁松 齊川 李滿(mǎn)元

目的 研究單胎孕婦與多胎孕婦血漿D-二聚體水平差異。方法 正常妊娠產(chǎn)婦1089名,其中977名單胎孕婦, 112名多胎孕婦, 調(diào)查其D-二聚體水平和個(gè)人信息, 并進(jìn)行統(tǒng)計(jì)分析。結(jié)果 無(wú)論在單胎還是多胎孕婦中D-二聚體水平與妊娠周數(shù)均呈正相關(guān)性。單胎孕婦和多胎孕婦血漿D-二聚體水平, 在妊娠前期單胎孕婦(96±29)ng/ml, 多胎孕婦(118±24)ng/ml, 差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)；在妊娠中期單胎孕婦(230±31)ng/ml, 多胎孕婦(238±37)ng/ml和后期單胎孕婦(362±29) ng/ml, 多胎孕婦(394±35)ng/ml, 差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。結(jié)論 多胎孕婦血漿D-二聚體水平比單胎孕婦明顯增高。

單胎；多胎；D-二聚體

正常妊娠期間, 母體處于高凝狀態(tài)［1］, 發(fā)生靜脈血栓的危險(xiǎn)增加［2］。妊娠期間D-二聚體水平生理性升高［3,4］,正常D-二聚體陽(yáng)性診斷標(biāo)準(zhǔn)不能用于診斷妊娠期間靜脈血栓, 妊娠可以影響D-二聚體的水平。

彌漫性血管內(nèi)凝血(DIC)形成之前D-二聚體水平升高, D-二聚體基礎(chǔ)水平的升高可能導(dǎo)致DIC的發(fā)生［5］, 而多胎妊娠D-二聚體基礎(chǔ)水平升高, 更增加了孕婦發(fā)生DIC的風(fēng)險(xiǎn)［6］。雖然以往的一些研究顯示多胎孕婦D-二聚體水平明顯高于單胎孕婦, 但不能確定多胎孕婦妊娠多久后D-二聚體水平呈明顯增高［7,8］。為了研究解決這個(gè)問(wèn)題本文回顧性的統(tǒng)計(jì)了1089名孕婦妊娠不同時(shí)期D-二聚體水平, 現(xiàn)報(bào)告如下。

1 資料與方法

1.1 一般資料 選取錦州市婦嬰醫(yī)院2012年1月～2013年12月正常妊娠期間檢測(cè)血漿D-二聚體的孕婦1089名, 排除患有高血壓和靜脈血栓患者。調(diào)查其懷孕時(shí)年齡、生產(chǎn)次數(shù)、分娩周數(shù)和D-二聚體水平。根據(jù)懷有胎兒數(shù)量將孕婦分為兩組：977名孕婦為單胎組, 112名孕婦為多胎組, 多胎組中106名為雙胞胎, 5名三胞胎, 1名四胞胎。按懷孕時(shí)間分為三個(gè)時(shí)期：妊娠前期(懷孕13周期之前)、妊娠中期(懷孕14～27周)、妊娠后期(懷孕28～42周)。統(tǒng)計(jì)每個(gè)時(shí)期孕婦所測(cè)D-二聚體水平, 如果一個(gè)時(shí)期測(cè)量多次D-二聚體水平, 則取最高值進(jìn)行統(tǒng)計(jì)分析。兩組懷孕時(shí)年齡、初產(chǎn)人數(shù)等一般資料比較, 差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05), 具有可比性。見(jiàn)表1。

1.2 測(cè)量方法 D-二聚體檢測(cè)使用免疫比濁法, 使用美國(guó)BECKMAN COULRER公司的ACL TOP全自動(dòng)血凝分析儀檢測(cè),所有試劑及耗材均使用美國(guó)BECKMAN COULRER公司的原廠試劑和耗材。本院實(shí)驗(yàn)室通過(guò)遼寧省室間質(zhì)控評(píng)測(cè), 且2013年全年儀器室內(nèi)質(zhì)控結(jié)果正常, 符合Westgard質(zhì)控規(guī)則。

1.3 統(tǒng)計(jì)學(xué)方法 應(yīng)用SPSS19.0統(tǒng)計(jì)軟件包進(jìn)行統(tǒng)計(jì)學(xué)分析。計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差( x-±s)表示, 采用t檢驗(yàn)；計(jì)數(shù)資料采用χ2檢驗(yàn)。以P＜0.05為差異具有統(tǒng)計(jì)學(xué)意義。

2 結(jié)果

無(wú)論是單胎孕婦還是多胎孕婦妊娠期間D-二聚體水平明顯隨著妊娠周數(shù)升高, 且呈正相關(guān)性。妊娠前期單胎和多胎的孕婦D-二聚體水平比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05),妊娠中期和后期單胎和多胎孕婦D-二聚體水平比較差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。見(jiàn)表1。

表1 單胎孕婦和多胎孕婦基本數(shù)據(jù)和D-二聚體水平比較［ x-±s, n (%)］

3 討論

通過(guò)本實(shí)驗(yàn), 可以發(fā)現(xiàn)婦女妊娠期間D-二聚體隨著妊娠周數(shù)明顯升高, 并且妊娠中期和后期多胎孕婦D-二聚體水平比同時(shí)期單胎孕婦有明顯增高, 此結(jié)果與以往一些報(bào)道［7,8］相似, 作者的結(jié)論也證實(shí)了這一點(diǎn)。

D-二聚體是交聯(lián)纖維蛋白在纖溶酶作用下產(chǎn)生的具有特異性的纖維蛋白降解產(chǎn)物的一個(gè)片段, D-二聚體是診斷繼發(fā)性纖溶亢進(jìn)的一個(gè)特異性指標(biāo)［9］。正常妊娠時(shí), 母體纖維蛋白、凝血因子等都有不同程度升高, 母體處于高凝狀態(tài), 纖溶活性降低, 所以D-二聚體水平可以有不同程度的生理性升高。

正常妊娠期間, 母體D-二聚體水平隨著妊娠周數(shù)的增加而增加［3］, 而多胎孕婦生產(chǎn)周數(shù)普遍較小, D-二聚體水平預(yù)測(cè)可能比單胎孕婦較低, 但實(shí)驗(yàn)室數(shù)據(jù)顯示多胎孕婦在懷孕后期D-二聚體水平明顯比單胎孕婦高, 因此孕婦D-二聚體之間的差異不是由妊娠周數(shù)的差異所導(dǎo)致的。多胎妊娠母體的凝血與纖溶變化復(fù)雜, 可能是由于胎盤(pán)體積增加,胎兒相關(guān)蛋白和妊娠甾體激素分泌增多所致［10］。有研究報(bào)道足月妊娠時(shí)血凝系統(tǒng)變化類(lèi)似DIC, 具體原因有待進(jìn)一步研究和發(fā)現(xiàn)［10］。

妊娠期間母體發(fā)生DIC的風(fēng)險(xiǎn)增加4～6倍［11］而多胎孕婦發(fā)生靜脈血栓的風(fēng)險(xiǎn)大約是單胎孕婦的2倍［12］。作者可以通過(guò)測(cè)定D-二聚體水平來(lái)初步預(yù)測(cè)孕婦發(fā)生DIC的風(fēng)險(xiǎn),但D-二聚體陽(yáng)性標(biāo)準(zhǔn)要根據(jù)孕婦的妊娠狀態(tài)來(lái)決定, 具體數(shù)值有待進(jìn)一步研究和制定。

總之, 作者的實(shí)驗(yàn)證實(shí), D-二聚體水平隨著妊娠周數(shù)的增加明顯增加, 并且多胎孕婦D-二聚體水平明顯比單胎孕婦高。因此臨床要特別注意孕婦, 尤其是多胎孕婦妊娠中后期的凝血與纖溶的變化, 早期判斷孕婦發(fā)生DIC的風(fēng)險(xiǎn), 保證母嬰健康。

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Comparison of the D-dimer levels between women with singleton and multifetal pregnancies

WANG Shuang, ZHAO Jin-song, QI Chuan, et al.
Department of Laboratory, Jinzhou Maternity and Infant Hospital, Jinzhou 121000, China

Objective To study the differences of the D-dimer levels between women with singleton and multifetal pregnancies.Methods D-dimer levels and personal information of 1,089 pregnant women were surveyed and analyzed.Among those women, there were 977 singleton pregnancies and 112 multifetal pregnancies.Results The D-dimer levels were significantly and positively correlated with gestational week in all women with singleton or multifetal pregnancies.The D-dimer levels determined at the first trimester did not differ significantly (P＞0.05), which was (96±29)ng/ml for singleton pregnancy and (118±24)ng/ml for multifetal pregnancy.The levels at the second trimester, (230±31) ng/ml for singleton pregnancy and (238±37)ng/ml for multifetal pregnancy, and the third trimester (362±29)ng/ml for singleton pregnancy and (394±35)ng/ml for multifetal

2014-07-04］

121000 錦州市婦嬰醫(yī)院檢驗(yàn)科