摘要
目的:探讨D二聚体联合血栓弹力图在低血栓风险孕妇中预测产后静脉血栓性疾病的价值。方法:收集2019年10月至2022年6月在嘉定区妇幼保健院早孕门诊就诊且按就诊时孕产妇静脉血栓栓塞风险因素评分表评分,评分为低血栓风险(0~2分)的孕妇732例,其中发生血栓46例,未发生血栓686例。比较血栓组和非血栓组孕妇孕早期、孕晚期D-D聚体及血栓弹力图指标及其动态变化,logistic回归分析判断各指标对静脉血栓性疾病的综合作用,以受试者工作特征曲线(ROC)判断各指标对产后静脉血栓性疾病的预测价值。结果:多因素结果显示,孕期D二聚体、Ma值增大,孕晚期TEG中的R值、K值、Ly30数值减小为产褥期VTE疾病的危险因素(P<0.05)。ROC曲线分析结果显示,早孕期Ma值结合晚孕期D二聚体、血栓弹力图中的R、K、Ma、Ly30联合诊断对于预测产褥期静脉血栓性疾病敏感性达87%,特异性达81%,曲线下面积(AUC)高于各指标单独检测(P<0.05)。结论:D二聚体与血栓弹力图联合作用对低血栓风险孕妇产后静脉血栓栓塞性疾病的发生有预测价值。
Objective:To examine whether D-dimer combined with thromboelastogram(TEG)can predict the presence of venous thromboembolism(VTE)in in pregnant women with low risk of thrombosis.Methods:A total of 732 pregnant women who attended the early pregnancy clinic in Maternal and Child Health Hospital of Jiading District from October 2019 to June 2022 and were scored as low thrombotic risk(0~2)according to the maternal venous thromboembolism risk factor scale at the time of consultation were collected,of which 46 cases had thrombosis and 686 cases did not have thrombosis.The D-D polymer and thromboelastogram parameters and their dynamic changes in the early and late pregnancy of pregnant women in the thrombosis group and the non-thrombosis group were compared.Logistic regression analysis was used to determine the comprehensive effect of each index on venous thrombotic diseases.The receiver operating characteristic curve(ROC)was used to determine the predictive value of each index for postpartum venous thrombotic diseases.Result:Multivariate results showed that the increase of D-dimer and Ma value during pregnancy and the decrease of R,K and Ly30 in TEG during late pregnancy were risk factors for VTE disease during puerperium(P<0.05).ROC curve analysis showed that the combined diagnosis of Ma value in early pregnancy combined with D-dimer in late pregnancy and R,K,Ma and Ly30 in thromboelastogram had a sensitivity of 87%and a specificity of 81%in predicting venous thrombotic diseases in puerperium.The area under the curve(AUC)was higher than that of each index(P<0.05).Conclusions:The combined effect of D-dimer and thromboelastogram parameters is predictive of postpartum venous thromboembolic disease in pregnant women at low thrombotic risk.
作者
朱玉婷
王霞红
徐先明
Zhu Yuting;Wang Xiahong;Xu Xianming(Department of Obstetrics and Gynecology,Maternal and Child Health Hospital of Jiading District,Shanghai 201800;Department of Obstetrics and Gynecology,Shanghai General Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 201620)
出处
《现代妇产科进展》
北大核心
2023年第8期581-585,共5页
Progress in Obstetrics and Gynecology
基金
嘉定区自然科学研究课题(No:JDKW-2020-0035)。
