摘要
目的探讨血栓弹力图(TEG)联合血清纤维蛋白降解产物(FDP)、血浆D-二聚体(D-D)对妊娠期糖尿病产妇并发下肢深静脉血栓(DVT)的预测价值。方法选取2021年1月至11月在本院分娩的129例妊娠期糖尿病产妇为观察组,另选取同期116例健康产妇作为对照组;根据观察组产后有无并发DVT,将其分为DVT组和非DVT组。分别比较观察组与对照组、DVT组与非DVT组产后24h的TEG参数及血清FDP、D-D水平;采用多因素Logistic回归分析妊娠期糖尿病产妇并发DVT的影响因素;采用受试者工作特征(ROC)曲线评价TEG联合血清FDP、D-D水平对妊娠期糖尿病产妇产后并发DVT的预测价值。结果观察组凝血时间(R)值、血块动力(K)值低于对照组,斜率值(α)、血块强度(MA)值、综合凝血指数(CI)值及血清FDP、D-D水平均高于对照组,差异有统计学意义(t/U值分别为16.693、14.787、3.118、6.173、12.098、9.154、14.258,P<0.05);妊娠期糖尿病产妇DVT并发率为15.50%(20/129);DVT组R值、K值均低于非DVT组,α角、MA、CI值及血清FDP、D-D水平均高于非DVT组,差异有统计学意义(t/U值分别为16.216、15.341、2.288、3.938、4.998、27.154、24.848,P<0.05)。多因素分析显示,剖宫产、产后卧床时间≥2d、合并高血压、高血脂症、血糖控制不良、血栓弹力图α角、MA值及血清FDP、D-D水平高表达均是妊娠期糖尿病产妇产后并发下肢DVT的危险因素(OR值分别为2.215、1.601、2.346、3.578、1.818、1.176、1.183、6.154、4.021,P<0.05),血栓弹力图R值及K值是妊娠期糖尿病产妇产后并发下肢DVT的保护因素(OR值分别为0.617、0.723,P<0.05)。经ROC曲线分析可知,TEG及血清FDP、D-D水平联合预测妊娠期糖尿病患者产后并发DVT的灵敏度(95.00%)、曲线下面积(0.944)均高于单独预测(P<0.05),特异度(82.57%)与单独预测差异无统计学意义(P>0.05)。结论TEG及血清FDP、D-D水平对妊娠期糖尿病产妇产后并发DVT均有一定的预测效能,但三者联合预测效能更理想,具有较高的临床价值,值得临床推广。
Objective To explore predictive value of thromboelastography(TEG)combined with detection of serum fibrinogen degradation products(FDP)and D-dimer(D-D)levels for development of postpartum deep vein thrombosis(DVT)in lower limbs of parturients with gestational diabetes mellitus(GDM).Methods 129parturients with GDM who delivered in our hospital from January to November 2021were selected as observation group,and another 116healthy pregnant women in the same period were selected as control group.The pregnant women in the observation group were divided into DVT group and non-DVT group according to presence or absence of DVT in their lower limbs after delivery.The TEG parameters,serum FDP and D-D levels within 24hafter delivery of the parturients were compared between the observation group and the control group,and between the DVT group and non-DVT group respectively.The multivariate Logistic regression analysis was used to analyze influencing factors for development of DVT in lower limbs of the parturients with GDM.The receiver operating characteristics(ROC)curve was used to evaluate predictive value of TEG combined with detection of serum FDP and D-D levels for development of postpartum DVT in the parturients with GDM.Results The coagulation time(R value)and clot dynamics(K value)of the parturients in the observation group were lower than those in the control group,but their slope value(α),clot strength value(MA),comprehensive coagulation index(CI)and serum FDP,D-D levels were significantly higher than those in the control group,and the differences were statistically significant(t/U=16.693,14.787,3.118,6.173,12.098,9.154and 14.258respectively,all P<0.05).The incidence rate of the complication of DVT in the parturients with GDM was 15.50%(20/129).The R value and K value of the parturients in the DVT group were lower than those in the non-DVT group,but theirαangle,MA and CI in TEG,and serum FDP,D-D levels were significantly higher than those in the non-DVT group,and the differences were statistically significant(t/U=16.216,15.341,2.288,3.938,4.998,27.154and 24.848respectively,P<0.05).Multivariate analysis showed that cesarean section,postpartum bed time≥2d,complicating with hypertension,complicating with hyperlipidemia,poor control of blood glucose level,andαand MA in the TEG and high serum levels of FDP and D-D were risk factors for development of postpartum lower limb DVT in the parturients with GDM(OR=2.215,1.601,2.346,3.578,1.818,1.176,1.183,6.154and 4.021respectively,all P<0.05),but the R value and the K value in the TEG were protective factors for developing postpartum lower limb DVT in the parturients with GDM(OR=0.617and 0.723 respectively,both P<0.05).The ROC curve analysis showed that the sensitivity(95.00%)and the area under the curve(AUC)(0.944)of combination of TEG and detection of serum FDP and D-D levels for predicting postpartum lower limbs DVT in the parturients with GDM were higher than those predicted separately(all P<0.05),but the specificity(82.57%)was not significantly different from that predicted alone(P>0.05).Conclusion TEG and detection of serum FDP and D-D levels all have certain predictive values for postpartum DVT in those parturients with GDM.While the predictive effect of combination of the three is more ideal,with higher clinical value,so it is worthy for clinical promotion.
作者
曹振平
周荣生
CAO Zhengping;ZHOU Rongsheng(Department of Gynecology and Obstetrics,The Third Clinical College of Anhui Medical University/The Third Hefei Municipal People′s Hospital,Anhui Hefei 230041,China)
出处
《中国妇幼健康研究》
2023年第4期109-116,共8页
Chinese Journal of Woman and Child Health Research
基金
合肥市第三人民医院2019年度院级科研项目(SYKY201908)。
关键词
血栓弹力图
血清纤维蛋白降解产物
血浆D-二聚体
妊娠期糖尿病
下肢深静脉血栓
thromboelastography(TEG)
serum fibrinogen degradation products(FDP)
plasm D-dimer(D-D)
gestational diabetes mellitus(GDM)
deep vein thrombosis(DVT)in lower limbs