摘要
目的:探究分娩前后血浆D-二聚体水平在筛查孕产妇肺血栓栓塞症(PTE)中的价值。方法:选择2016年1月至2020年12月在云南省第一人民医院产科产检、分娩,并在产后确诊为PTE的病例93例为研究组,选取同期分娩未发生血栓性疾病的产妇200例为对照组,回顾性分析两组患者分娩前0~72小时、分娩后24~48小时、分娩后48~72小时3个时间段的血浆D-二聚体值。结果:在分娩前0~72小时、分娩后24~48小时、分娩后48~72小时3个时间段内的血浆D-二聚体值,研究组明显高于对照组,差异有统计学意义(P<0.001);两组分娩后两个时间段的血浆D-二聚体值均明显高于分娩前(P<0.001),但同组分娩后2个时间段比较差异无统计学意义(P>0.05);研究组ROC曲线分析提示血浆D-二聚体在分娩前0~72小时、分娩后24~48小时及分娩后48~72小时预测PTE的最佳截断值分别为4.19μg/ml、5.43μg/ml、4.79μg/ml,特异度分别为83.5%、87.0%、85.6%,分娩前的曲线下面积(AUC)、灵敏度、约登指数分别为0.643、43%、26.5%,均低于分娩后24~48小时和分娩后48~72小时(分别为0.849、72.1%、59.0%和0.877、79.2%、64.8%)。结论:分娩前后血浆D-二聚体值的变化对产科PTE有较好的预测价值,分娩后的预测价值高于分娩前;当分娩前0~72小时、分娩后24~48小时及分娩后48~72小时的血浆D-二聚体值分别高于4.19μg/ml、5.43μg/ml、4.79μg/ml,结合患者合并相关产科因素,建议及时实施影像学检查明确诊断,改善妊娠分娩相关不良结局。
Objective:To investigate the value of plasma D-dimer levels before and after delivery in screening for maternal pulmonary embolism.Methods:From January 2016 to December 2020,93 women who delivered in the Department of Obstetrics of The First People′s Hospital of Yunnan Province and were diagnosed with pulmonary embolism after delivery were selected as the study group,and 200 women who delivered during the same period without thrombotic diseases were selected as the control group.Plasma D-dimer values of 2 groups were detected and retrospectively analyzed at 0-72 hours before delivery,24-48 hours after delivery,and 48-72 hours after delivery to screen maternal PTE.Results:The plasma D-dimer level in the study group was significantly higher than that in the control group at 0-72 hours before delivery,24-48 hours after delivery and 48-72 hours after delivery,with statistical significance(P<0.001).Plasma D-dimer values at two time periods after delivery were significantly higher than those before delivery(P<0.001),but there was no significant difference between the two time periods after delivery(P>0.05).ROC curve analysis of D-dimer values which are used to predict maternal pulmonary embolism showed that the optimal cut-off values of D-dimer values detected 0-72 hours before delivery,24-48 hours after delivery and 48-72 hours after delivery were 4.19μg/ml,5.43μg/ml and 4.79μg/ml,respectively.The AUC,sensitivity,and Youden index before delivery were 0.643,43%,and 26.5%respectively,which were all lower than those of 24-48 hours after delivery and 48-72 hours after delivery(0.849,72.1%,59%vs.0.877,79.2%,64.8%respectively),the specificity in the order of time before and after delivery was 83.5%,87.0%,and 85.6%respectively.Conclusions:The change of plasma D-dimer value before and after delivery has a good predictive value for the diagnosis of obstetric pulmonary embolism.The predictive value after delivery is higher than that before delivery.When D-dimer values were detected 0-72 hours before delivery,24-48 hours af
作者
张乃羚
杨庆欢
ZHANG Nailing;YANG Qinghuan(Department of Obstetrics,The First People′s Hospital of Yunnan Province,Kunming Yunnan 650032,China;School of Public Health,Kunming Medical University,Kunming Yunnan 650500,China)
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2022年第6期471-474,共4页
Journal of Practical Obstetrics and Gynecology
关键词
产科肺栓塞
D-二聚体
筛查
Obstetric pulmonary embolism
D-dimer
Screening
