摘要
目的探讨血浆抗凝血酶Ⅲ(ATⅢ)对孕产妇脑静脉窦血栓(CVST)的预测性诊断价值。方法以2012年1月至2017年1月在该院接受首次产检的孕产妇137例为研究对象,开展前瞻性随访研究,纳入对象均表现出孕早期首次产检时D-二聚体(D-D)>4mg/L或纤维蛋白原降解产物(FDP)>4mg/L。按围产期是否出现CVST,将其划分为观察组(n=21,出现CVST)和对照组(n=116,未出现CVST)。检测并对比2组血小板计数(PLT)、凝血酶原时间(PT)、D-D、FDP、ATⅢ水平,并测评ATⅢ与其他指标的相关性,利用受试者工作特征(ROC)曲线分析ATⅢ对诊断CVST的效能,利用Logistic回归分析明确ATⅢ与CVST发生的关系。结果观察组ATⅢ水平明显低于对照组,PT明显长于对照组,差异均有统计学意义(P<0.05)。ATⅢ水平与PT呈显著负相关(r=-0.806,P=0.001)。ATⅢ对早期诊断CVST有较高价值,ROC曲线下面积为0.849,ATⅢ的最佳截断值为72.8%,此时灵敏度为0.857,特异度为0.698。ATⅢ偏低是CVST发生的独立危险因素(OR=2.711,P=0.001)。结论孕早期检测ATⅢ对早期诊断CVST有一定价值,建议对孕早期凝血及纤溶功能异常孕产妇同时检测该指标。
Objective To investigate the predictive value of plasma antithrombin Ⅲ （ATⅢ） in the diagnosis of cerebral venous sinus thrombosis （CVST） in pregnant women. Methods A total of 137 pregnant women who received first production inspection in our hospital from January 2012 to January 2017 were involved to carry out prospective follow-up study.These subjects all showed that D-Dimer （D-D） was above 4 mg/L or fibrinogen degradation products （FDP） was above 4 mg/L.According to whether CVST occurred,they were divided into observation group （ n =21,CVST occurred） and control group （ n =116,CVST did not occur）.Their platelet count （PLT）,prothrombin time （PT）,D-D,FDP,ATⅢ were detected and compared,the correlation among ATⅢ and other indexes were analyzed,the predictive value of ATⅢ in the diagnosis of CVST were analyzed by receiver operating characteristic （ROC） curve,the relationship between ATⅢ and CVST were analyzed by binary logistic regression. Results ATⅢ in the observation group was much lower,and PT was much longer than those in the control group,the differences were statistical significant （ P 〈0.05）.ATⅢ negatively correlated with PT （ r =-0.806, P =0.001）.ATⅢ had reliable value for early diagnosis of CVST,the area under ROC was 0.849 ,and the optimal cutoff value of ATⅢ was 72.8%,where the sensitivity was 0.857 , and the specificity was 0.698.Low ATⅢ was an independent risk factor for CVST （ OR =2.711, P = 0.001 ）. Conclusion The detection of ATⅢ in early pregnancy has certain value for early diagnosis of CVST.It is suggested that for cases with dysfunction of coagulation and fibrinolysis,ATⅢ should be detected at the same time.
作者
毕瑞
张波
尹建威
杨亮
BI Rui;ZHANG Bo;YIN Jianwei;YANG Liang(Department of Obstetrics and Gynecology;Department of Gastroenterology;the Second Department of Respiratory;the Second Department ofNeurology,Yulin Second Hospital of Shaanxi Province,Yulin,Shaanxi 719051,China)
出处
《检验医学与临床》
CAS
2018年第9期1232-1234,1238,共4页
Laboratory Medicine and Clinic
基金
陕西省医学科技攻关计划项目(201405107)
关键词
抗凝血酶Ⅲ
孕产妇
脑静脉窦血栓
antithrombin Ⅲ
pregnant women
cerebral venous sinus thrombosis
