CAJ | 학술논문

目的：通过对孕产妇产前凝血四项[凝血酶原时间（PT）、部分活化凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原定量（FIB）]以及 D-二聚体（DD）和血小板（PLT）的联合检测，探讨其在判断孕产妇凝血功能、出血危险性方面的临床意义。方法收集2012年6月至2013年9月来该院就诊孕妇及健康体检育龄非妊娠妇女共795人，分为正常妊娠组（孕早期、孕中期、孕晚期、临产期）、产科意外组、妊娠伴其他疾病组和健康对照组。同时检测 PT、APTT、TT、FIB、DD、PLT，并进行相关统计分析。结果正常妊娠组 DD、FIB 明显高于健康对照组（P ＜0．05），PT、APTT 明显低于健康对照组（P ＜0．05），两组 TT 比较差异无统计学意义（P ＞0．05）；产科意外组、妊娠伴其他疾病组 DD、FIB 明显高于正常妊娠组（P ＜0．05），PT 明显低于正常妊娠组（P ＜0．05）。产科意外组、妊娠伴其他疾病组 PLT 明显低于正常妊娠组（P ＜0．05）。三项联合检测诊断孕产妇产科意外发生的敏感性和特异性大大优于单项或两项联合检测。结论产前进行凝血四项、DD 和 PLT 的联合检测，可初步判定孕产妇妊娠周期的凝血状况，帮助治疗孕产妇异常出血，对制定生产方案及预防产科意外的发生有着重要的指导意义。
목적：통과대잉산부산전응혈사항[응혈매원시간（PT）、부분활화응혈활매시간（APTT）、응혈매시간（TT）、섬유단백원정량（FIB）]이급 D-이취체（DD）화혈소판（PLT）적연합검측，탐토기재판단잉산부응혈공능、출혈위험성방면적림상의의。방법수집2012년6월지2013년9월래해원취진잉부급건강체검육령비임신부녀공795인，분위정상임신조（잉조기、잉중기、잉만기、임산기）、산과의외조、임신반기타질병조화건강대조조。동시검측 PT、APTT、TT、FIB、DD、PLT，병진행상관통계분석。결과정상임신조 DD、FIB 명현고우건강대조조（P ＜0．05），PT、APTT 명현저우건강대조조（P ＜0．05），량조 TT 비교차이무통계학의의（P ＞0．05）；산과의외조、임신반기타질병조 DD、FIB 명현고우정상임신조（P ＜0．05），PT 명현저우정상임신조（P ＜0．05）。산과의외조、임신반기타질병조 PLT 명현저우정상임신조（P ＜0．05）。삼항연합검측진단잉산부산과의외발생적민감성화특이성대대우우단항혹량항연합검측。결론산전진행응혈사항、DD 화 PLT 적연합검측，가초보판정잉산부임신주기적응혈상황，방조치료잉산부이상출혈，대제정생산방안급예방산과의외적발생유착중요적지도의의。
Objective To investigate the clinical significance of the antenatal detection of four indices of coagulation(PT,APTT, TT,FIB),D-dimer(DD)and platelet(PLT)in the judgment of parturient coagulation function and bleeding risk.Methods 795 pregnant women and childbearing age non-pregnant women with physical examination in this hospital from June 2012 to September 2013 were collected and divided into the normal pregnancy group(early pregnancy,middle pregnancy,late pregnancy,parturient pe-riod),obstetric accident group,pregnancy complicating other disease group and healthy control group.At the same time,PT, APTT,TT,FIB,DD and PLT were detected and the related statistical analysis was conducted.Results DD and FIB in the normal pregnancy group were significantly higher than those in the healthy control group(P<0.05),PT and APTT were significantly low-er than those in the healthy control group(P <0.05),TT had no statistically significant difference between these two groups(P >0.05 );DD and FIB in the obstetric accident group and the pregnancy complicating other disease group were significantly higher than those in the normal pregnancy group(P <0.05),while PT was significantly lower than that in the normal pregnancy group(P <0.05).PLT in the obstetric accident group and the pregnancy complicating other disease group was significantly lower than that in the normal pregnancy group(P <0.05).The sensitivity and specificity of the combined detection of 3 indices in diagnosing the ob-stetrical accidents were greatly superior to those of the single index detection or the combined detection of two indices.Conclusion The prenatal combination detection of four coagulation indices,DD and PLT can preliminarily judge the coagulation status of preg-nancy period in pregnant women,help to treat abnormal bleeding of pregnant women an possess the important guidance significance in formulating the labor scheme and preventing the occurrence of obstetric accidents.