中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
CHINESE JOURNAL OF LABORATORY MEDICINE
2011年
7期
580-585
,共6页
孕妇%产后期%D-二聚体%参考值%静脉血栓%弥漫性血管内凝血
孕婦%產後期%D-二聚體%參攷值%靜脈血栓%瀰漫性血管內凝血
잉부%산후기%D-이취체%삼고치%정맥혈전%미만성혈관내응혈
Pregnant women%Postpartum period%D-dimer%Reference values%Venous thrombosis%Disseminated intravascular coagulation
目的 建立浙江地区汉族孕产妇D-二聚体参考区间.方法 选取2009年3月至2010年8月浙江大学医学院附属妇产科医院健康孕妇669名、健康产妇578名、发生静脉血栓或DIC孕产妇8例以及健康非孕产妇对照者80名.将健康孕产妇按孕周、产后不同时间及不同分娩方式分组:(1)≤13周组120名,14～20周组120名,21～27周组145名,28～34周组147名,≥35周组137名;(2)自然分娩后第1天组163名,自然分娩后第2天组121名;(3)剖宫产后第1天组166名,剖宫产后第2天组128名.将上述各组按年龄再分为＜30岁组和≥30岁组.采集所有健康孕产妇柠檬酸钠抗凝静脉血1.8 ml,采用STA-R Evolution全自动血凝仪检测其血浆D-二聚体浓度,确定相应的参考区间.孕产妇D-二聚体浓度为偏态分布数据,采用百分位数(P95)表示参考区间的单侧上限.采用本研究建立的参考区间评估8例患静脉血栓或DIC孕产妇的D-二聚体水平,以验证建立的参考区间的有效性.结果 年龄＜30岁的孕妇组及健康对照组中,孕周≤13周、14～20周、21～27周、28～34周、≥35周的孕妇组及健康对照组血浆D-二聚体水平分别为0.25(0.17～0.37)、0.51(0.38～0.75)、0.75(0.57～1.10)、1.14(0.80～1.48)、1.60(1.14～1.89)、0.20(0.10～0.28) mg/L,差异有统计学意义(H=239.24,P＜0.05);年龄≥30岁的孕妇组及健康对照组中,上述各组的D-二聚体水平分别为0.28(0.14～0.38)、0.50(0.36～0.65)、0.83(0.59～1.41)、0.93(0.68～1.37)、1.47(1.22～1.84)、0.17(0.12～0.25)mg/L,差异有统计学意义(H=127.75,P＜0.05).年龄＜30岁的产妇组中,自然分娩后第1天、自然分娩后第 2天、剖宫产后第1天、剖宫产后第2天产妇组的血浆D-二聚体水平分别为2.45(1.51～3.77)、1.30(0.97～1.96)、2.68(1.52～3.74)、1.55(1.10～2.10) mg/L,差异有统计学意义(H=64.85,P＜0.05);年龄≥30岁的产妇组中,上述各组的血浆D-二聚体水平分别为2.20(1.33～3.54)、1.33(1.02～2.14)、2.27(1.66～3.17)、1.62(1.26～2.69) mg/L,差异有统计学意义(H=18.64,P＜0.05).孕产妇血浆D-二聚体水平在不同孕周、产后不同时间、不同分娩方式组间差异有统计学意义,应该制定不同的参考区间.孕周≤13周、14～20周、21～27周、28～34周、≥35周的孕妇血浆D-二聚体参考区间分别为≤0.64 mg/L、≤1.54 mg/L、≤2.60 mg/L、≤3.01 mg/L、≤3.19 mg/L;自然分娩后第1天、自然分娩后第2天、剖宫产后第1天、剖宫产后第2天的血浆D-二聚体参考区间分别为≤7.83 mg/L、≤3.29 mg/L、≤9.95 mg/L、≤3.80 mg/L.采用上述参考区间评估8例患静脉血栓或DIC的孕产妇的D-二聚体水平,均为阳性结果.结论 本研究初步建立并评估了浙江地区汉族孕产妇血浆D-二聚体参考区间,提高了D-二聚体检测在孕产妇人群中的应用价值.
目的 建立浙江地區漢族孕產婦D-二聚體參攷區間.方法 選取2009年3月至2010年8月浙江大學醫學院附屬婦產科醫院健康孕婦669名、健康產婦578名、髮生靜脈血栓或DIC孕產婦8例以及健康非孕產婦對照者80名.將健康孕產婦按孕週、產後不同時間及不同分娩方式分組:(1)≤13週組120名,14～20週組120名,21～27週組145名,28～34週組147名,≥35週組137名;(2)自然分娩後第1天組163名,自然分娩後第2天組121名;(3)剖宮產後第1天組166名,剖宮產後第2天組128名.將上述各組按年齡再分為＜30歲組和≥30歲組.採集所有健康孕產婦檸檬痠鈉抗凝靜脈血1.8 ml,採用STA-R Evolution全自動血凝儀檢測其血漿D-二聚體濃度,確定相應的參攷區間.孕產婦D-二聚體濃度為偏態分佈數據,採用百分位數(P95)錶示參攷區間的單側上限.採用本研究建立的參攷區間評估8例患靜脈血栓或DIC孕產婦的D-二聚體水平,以驗證建立的參攷區間的有效性.結果 年齡＜30歲的孕婦組及健康對照組中,孕週≤13週、14～20週、21～27週、28～34週、≥35週的孕婦組及健康對照組血漿D-二聚體水平分彆為0.25(0.17～0.37)、0.51(0.38～0.75)、0.75(0.57～1.10)、1.14(0.80～1.48)、1.60(1.14～1.89)、0.20(0.10～0.28) mg/L,差異有統計學意義(H=239.24,P＜0.05);年齡≥30歲的孕婦組及健康對照組中,上述各組的D-二聚體水平分彆為0.28(0.14～0.38)、0.50(0.36～0.65)、0.83(0.59～1.41)、0.93(0.68～1.37)、1.47(1.22～1.84)、0.17(0.12～0.25)mg/L,差異有統計學意義(H=127.75,P＜0.05).年齡＜30歲的產婦組中,自然分娩後第1天、自然分娩後第 2天、剖宮產後第1天、剖宮產後第2天產婦組的血漿D-二聚體水平分彆為2.45(1.51～3.77)、1.30(0.97～1.96)、2.68(1.52～3.74)、1.55(1.10～2.10) mg/L,差異有統計學意義(H=64.85,P＜0.05);年齡≥30歲的產婦組中,上述各組的血漿D-二聚體水平分彆為2.20(1.33～3.54)、1.33(1.02～2.14)、2.27(1.66～3.17)、1.62(1.26～2.69) mg/L,差異有統計學意義(H=18.64,P＜0.05).孕產婦血漿D-二聚體水平在不同孕週、產後不同時間、不同分娩方式組間差異有統計學意義,應該製定不同的參攷區間.孕週≤13週、14～20週、21～27週、28～34週、≥35週的孕婦血漿D-二聚體參攷區間分彆為≤0.64 mg/L、≤1.54 mg/L、≤2.60 mg/L、≤3.01 mg/L、≤3.19 mg/L;自然分娩後第1天、自然分娩後第2天、剖宮產後第1天、剖宮產後第2天的血漿D-二聚體參攷區間分彆為≤7.83 mg/L、≤3.29 mg/L、≤9.95 mg/L、≤3.80 mg/L.採用上述參攷區間評估8例患靜脈血栓或DIC的孕產婦的D-二聚體水平,均為暘性結果.結論 本研究初步建立併評估瞭浙江地區漢族孕產婦血漿D-二聚體參攷區間,提高瞭D-二聚體檢測在孕產婦人群中的應用價值.
목적 건립절강지구한족잉산부D-이취체삼고구간.방법 선취2009년3월지2010년8월절강대학의학원부속부산과의원건강잉부669명、건강산부578명、발생정맥혈전혹DIC잉산부8례이급건강비잉산부대조자80명.장건강잉산부안잉주、산후불동시간급불동분면방식분조:(1)≤13주조120명,14～20주조120명,21～27주조145명,28～34주조147명,≥35주조137명;(2)자연분면후제1천조163명,자연분면후제2천조121명;(3)부궁산후제1천조166명,부궁산후제2천조128명.장상술각조안년령재분위＜30세조화≥30세조.채집소유건강잉산부저몽산납항응정맥혈1.8 ml,채용STA-R Evolution전자동혈응의검측기혈장D-이취체농도,학정상응적삼고구간.잉산부D-이취체농도위편태분포수거,채용백분위수(P95)표시삼고구간적단측상한.채용본연구건립적삼고구간평고8례환정맥혈전혹DIC잉산부적D-이취체수평,이험증건립적삼고구간적유효성.결과 년령＜30세적잉부조급건강대조조중,잉주≤13주、14～20주、21～27주、28～34주、≥35주적잉부조급건강대조조혈장D-이취체수평분별위0.25(0.17～0.37)、0.51(0.38～0.75)、0.75(0.57～1.10)、1.14(0.80～1.48)、1.60(1.14～1.89)、0.20(0.10～0.28) mg/L,차이유통계학의의(H=239.24,P＜0.05);년령≥30세적잉부조급건강대조조중,상술각조적D-이취체수평분별위0.28(0.14～0.38)、0.50(0.36～0.65)、0.83(0.59～1.41)、0.93(0.68～1.37)、1.47(1.22～1.84)、0.17(0.12～0.25)mg/L,차이유통계학의의(H=127.75,P＜0.05).년령＜30세적산부조중,자연분면후제1천、자연분면후제 2천、부궁산후제1천、부궁산후제2천산부조적혈장D-이취체수평분별위2.45(1.51～3.77)、1.30(0.97～1.96)、2.68(1.52～3.74)、1.55(1.10～2.10) mg/L,차이유통계학의의(H=64.85,P＜0.05);년령≥30세적산부조중,상술각조적혈장D-이취체수평분별위2.20(1.33～3.54)、1.33(1.02～2.14)、2.27(1.66～3.17)、1.62(1.26～2.69) mg/L,차이유통계학의의(H=18.64,P＜0.05).잉산부혈장D-이취체수평재불동잉주、산후불동시간、불동분면방식조간차이유통계학의의,응해제정불동적삼고구간.잉주≤13주、14～20주、21～27주、28～34주、≥35주적잉부혈장D-이취체삼고구간분별위≤0.64 mg/L、≤1.54 mg/L、≤2.60 mg/L、≤3.01 mg/L、≤3.19 mg/L;자연분면후제1천、자연분면후제2천、부궁산후제1천、부궁산후제2천적혈장D-이취체삼고구간분별위≤7.83 mg/L、≤3.29 mg/L、≤9.95 mg/L、≤3.80 mg/L.채용상술삼고구간평고8례환정맥혈전혹DIC적잉산부적D-이취체수평,균위양성결과.결론 본연구초보건립병평고료절강지구한족잉산부혈장D-이취체삼고구간,제고료D-이취체검측재잉산부인군중적응용개치.
Objective To establish D-dimer normal reference range in pregnant and postpartum women in Zhejiang Han population.Methods Plasma samples were collected from 669 healthy pregnant women, 578 healthy postpartum women, 8 venous thrombosis or DIC patients and 80 healthy non-pregnant women in Women′s Hospital, School of Medicine, Zhejiang University from March 2009 to August 2010.According to different gestational week, postpartum days and delivery pattern, the healthy pregnant and postpartum women were stratified into 3 groups: (1) ≤13 weeks (n=120), 14-20 weeks (n=120), 21-27 weeks (n=145), 28-34 weeks (n=147), ≥35 weeks (n=137);(2) The first day after vaginal delivery (n=163), the second day after vaginal delivery (n=121);(3) The first day after cesarean sections (n=166), the second day after cesarean sections (n=128). These groups were further stratified based on age: ＜30 years old and ≥30 years old.All blood samples were drawn in citrate sodium anticoagulated blood.D-dimer concentration was determined by STA-R Evolution coagulation analyzer.Since D-dimer concentration showed non-normal distribution, the normal values (one-tailed) were established by using (P95) percentile method.The results of 8 patients were used to validate the established normal values.Results In the group of ＜30 years old, the D-dimer values[M(P25-P75)]in group of ≤13 weeks, 14-20 weeks, 21-27 weeks, 28-34 weeks, ≥35 weeks and healthy non-pregnant women were 0.25(0.17-0.37), 0.51(0.38-0.75), 0.75(0.57-1.10), 1.14(0.80-1.48), 1.60(1.14-1.89) and 0.20(0.10-0.28) mg/L, respectively, which showed statistical difference(H=239.24, P＜0.05).In the group of ≥30 years old, the D-dimer values of the above different groups were 0.28(0.14-0.38), 0.50(0.36-0.65), 0.83(0.59-1.41), 0.93(0.68-1.37), 1.47(1.22-1.84) and 0.17(0.12-0.25) mg/L, respectively, which also showed statistical difference(H=127.75, P＜0.05).In the group of ＜30 years old, the D-dimer values were 2.45(1.51-3.77), 1.30(0.97-1.96), 2.68(1.52-3.74) and 1.55(1.10-2.10) on the first and second day after vaginal delivery and cesarean section, respectively, which showed statistical difference (H=64.85,P＜0.05).In the group of ≥30 years old, the corresponding values were 2.20(1.33-3.54), 1.33(1.02-2.14), 2.27(1.66-3.17) and 1.62(1.26-2.69), respectively, which also showed statistical difference(H=18.64, P＜0.05).D-dimer normal values were established based on different gestational week, postpartum days and delivery pattern.The normal values of ≤13 weeks, 14-20 weeks, 21-27 weeks, 28-34 weeks and ≥35 weeks were ≤0.64 mg/L, ≤1.54 mg/L, ≤2.60 mg/L, ≤3.01 mg/L and ≤3.19 mg/L, respectively. The normal values of 1st day after vaginal delivery, 2nd day after vaginal delivery,1st day after cesarean sections and 2nd day after cesarean sections were ≤7.83 mg/L, ≤3.29 mg/L, ≤9.95 mg/L and ≤3.80 mg/L.All 8 patients showed positive results with the above normal values.Conclusion D-dimer normal values in pregnant and postpartum women in Zhejiang Han population are established, which can improve the application values of D-dimer in the pregnant and postpartum population.
