妊娠期常规凝血指标参考区间的建立与意义
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云南省高层次卫生计生技术人才培养经费资助(D-2018041);昆明医科大学硕士研究生创新基金(2020S197)


Establishment and analysis of the reference interval of routine coagulation indexes during pregnancy
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    摘要:

    目的 研究健康孕妇不同孕期的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、D-二聚体(DD)、抗凝血酶(AT)、纤维蛋白(原)降解产物(FDP)水平变化,探讨年龄因素对妊娠妇女凝血指标水平的影响,建立孕妇不同孕期PT、APTT、FIB、TT、DD、AT、FDP的参考区间。方法 选取健康孕妇406例和健康非孕对照组110例为研究对象,将孕妇分为孕早期组152例、孕中期组124例和孕晚期组130例,分别检测每组相关凝血指标并分析其水平变化。分析年龄对每组孕妇凝血功能的影响。采用非参数法建立孕妇不同孕期的PT、APTT、FIB、TT、DD、AT、FDP的参考区间并进行验证。结果 在年龄<30岁及年龄≥30岁两亚组中,孕早期、孕中期、孕晚期的凝血指标水平比较,差异无统计学意义(均P>0.05)。PT水平在孕早、中、晚期间差异不显著(P>0.05),参考区间为10.20~11.90 s。APTT水平在孕早、中期间差异不显著(P>0.05),参考区间为23.3~29.6 s,晚期参考区间为22.8~29.4 s。FIB、TT、DD、AT、FDP的水平在孕早、中、晚期间差异显著(P<0.05),在孕早期的参考区间分别为:2.59~4.6 g/L、13.3~16.1 s、0.82 μg/mL、(73.3~101.9)%、2.56 μg/mL,在孕中期的参考区间分别为:2.59~5.1 g/L、13~15.9 s、1.35 μg/mL、(70.5~103.3)%、4.4 μg/mL,在孕晚期的参考区间分别为:3.01~5.98 g/L、13.3~15.7 s、3.4 μg/mL、(73.4~113.6)%、8.63 μg/mL。结论 初步建立了孕妇不同孕期常规凝血指标的参考区间,为临床诊断和预防孕产妇出血提供实验室依据。

    Abstract:

    Objective To study the changes in the levels of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), D-dimer (DD), thrombin (AT) and fibrin (proto) degradation products (FDP), explore the influence of age factors on the levels of coagulation indicators in pregnant women, and establish PT, APTT, FIB, TT, DD, AT, FDP reference intervals in different pregnancy periods. Methods We selected 406 healthy pregnant women and 110 non-pregnant healthy controls. The pregnant women were divided into 152 cases in the first trimester group, 124 cases in the second trimester group, and 130 cases in the third trimester group. The relevant coagulation indexes of each group were detected and their level changes were analyzed. Analyze the influence of age on the coagulation function of each group of pregnant women. The non-parametric method was used to establish and verify the reference intervals of PT, APTT, FIB, TT, DD, AT, FDP of pregnant women in different pregnancy periods. Results There was no significant difference in coagulation index levels in the first trimester, the second trimester, and the third trimester in the two groups of age <30 years old and age ≥30 years old (P>0.05). The PT level did not change significantly during the early, middle and late pregnancy (P>0.05), and the reference interval was 10.20-11.90 s. The APTT level was not significantly different during the early and middle pregnancy (P>0.05), the reference interval was 23.3-29.6 s, and the late reference interval was 22.8-29.4 s. The levels of FIB, TT, DD, AT, and FDP were significantly different during the early, middle and late pregnancy (P<0.05). The reference intervals in the first trimester were 2.59~4.6 g/L, 13.3~16.1 s, 0.82 μg, respectively /mL, (73.3~101.9)%, 2.56 μg/mL, the reference intervals in the second trimester are: 2.59~5.1 g/L, 13~15.9 s, 0.95 μg/mL, (70.5~103.3)%, 4.4 μg /mL, the reference intervals in the third trimester are: 3.01~5.98 g/L, 13.3~15.7 s, 3.4 μg/mL, (73.4~113.6)%, 8.63 μg/mL.Conclusion The reference interval for routine coagulation indexes of pregnant women in different pregnancy periods has been preliminarily established to provide laboratory evidence for clinical diagnosis and prevention of maternal bleeding.

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  • 在线发布日期: 2022-01-12
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