摘要
【目的】研究常规止凝血功能指标和分子标志物在正常孕妇和产科早期弥漫性血管内凝血(DIC)患者中的变化,了解它们在诊断产科早期DIC中的价值和意义。【方法】将107例正常孕妇按孕期分为早孕组(≤12周)、中孕组(13～28周)和晚孕组(≥29周),检测了31例早孕、14例中孕、62例晚孕、34例产科早期DIC和31例正常对照的常规止凝血功能指标[凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(Fbg)、血小板(PLT)]和分子标志物F1+2、TM和D-dimer。[结果]PT、APTT在各实验组间差异无统计学意义(P>0.05),早期DIC组PLT(155±60)×109/L低于正常对照组(241±63)×109/L和妊娠各期组(分别为(233±64)×109/L、(203±50)×109/L、(216±55)×109/L)(P<0.05),Fbg、F1+2、TM、D-dimer随着妊娠时间的延长浓度逐渐升高(P<0.05),早期DIC组Fb(g4.0±1.0)g/L与中孕组(3.8±0.8)g/L、晚孕组(4.1±0.5)g/L相比差异无统计学意义(P>0.05),早期DIC组F1+2(4.43±1.43)nmol/L、TM(31.5±8.5)μg/L、D-dimer630(479)μg/L浓度显著升高,明显高于正常对照组和妊娠各期组(P<0.05)。除PLT和Fbg之间不存在直线相关关系外,指标F1+2、TM、D-dimer、PLT、Fbg间均存在直线相关关系或等级相关关系(P<0.05)。【结论】PT、APTT不能及时反映孕妇体内的高凝状态,不能作为早期诊断产科早期DIC的敏感指标。Fbg是反映机体高凝状态的一个指标,但不是早期诊断产科DIC的敏感指标。F1+2、TM、D-dimer可作为早期诊断产科DIC的敏感指标。
[Objective] To study the changes of routine coagulation tests and prothrombotic molecular markers in normal pregnant women and the patients with disseminated intravascular coagulation （DIC）, and to study the clinical value of these parameters to diagnose DIC early. [Methods] Routine coagulation tests （PT, APTT, Fbg,PLT） and the levels of molecular markers included F1＋2, TM, D-dimer were determined in plasma of 34 DIC patients, 31 normal controls and 107 normal pregnant women divided into 3 groups as early-pregnancy group, middlepregnancy group, and later-pregnancy group. [Results] No significant difference were found in the amounts of PT and APTT in all tested groups （P 〉0.05）. The amounts of PLT in the patients with DIC （155±60）×10^9/L was significantly lower than that in normal controls （241±63）×10^9/L and normal pregnant women [（233±64）×10^9/L, （203±50）10^9/L,（216±55）×10^9/L, respectively]（P〈 0.05）. The amounts of Fbg, F1＋2, TM, D-dimer increased with increasing of pregnant month （P〈 0.05）. No significant difference was found in the amounts of Flag in the patients with DIC and normal pregnant women except early-pregnant women （P 〉0.05）. The amounts of F1＋2（4.43±1.43） nmol/L, TM （31.5±8.5）μg/L, D-dimer 630 （479）μg/L were significantly higher than that in normal controls and normal pregnant women （P〈 0.05）. Significant correlation were found among F1 ＋2, TM, D-dimer, PLT, Fbg （P〈 0.05）. However, no significant correlation was found between PLT and Fbg （P 〉0.05）. [Conclusions] PT and APTr can not early reflect coagulation state and can not be used as sensitive parameters for early diagnosis of DIC. Fbg can indicate the activated coagulation state; however, it can not be used as sensitive parameters for early diagnosis of DIC. F1＋2, TM, and D-dimer are valuable for early diagnosis of DIC.
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2006年第2期203-207,211,共6页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广东省重点科技攻关资助项目(ZKB04701S)
