CAJ | 학술논문

目的：探讨正常孕妇血浆D-二聚体的变化特点，建立本实验室正常孕妇血浆D-二聚体的参考区间。方法选取正常孕妇664例、非孕正常女性对照者100名（正常对照组），产后发生弥散性血管内凝血（DIC）或静脉血栓患者18例。将正常孕产妇按孕周分为5组：（1）孕＜20周（127例）；（2）孕20～32周（86例）；（3）孕32周至临产≥32周（191例）；（4）产后第1天（130例）；（5）产后第2天（130例）。采用 SYSMEX CA7000全自动凝血仪检测所有正常孕妇及正常对照组血浆 D-二聚体浓度，确定相应的参考区间。孕妇 D-二聚体浓度呈偏态分布，采用百分位数（P95）表示参考区间的单侧上限。采用建立的参考区间评估18例产后发生 DIC 或静脉血栓孕产妇的 D-二聚体水平，验证该参考区间的有效性。结果D-二聚体随着妊娠期的延长逐渐升高，从20周开始至32周逐渐上升，32周以后升高幅度最大，孕＜20周组、孕20～32周组及孕≥32周组 D-二聚体参考区间分别为＜1．54 mg/L、＜3．46 mg/L及＜4．96 mg/L ；分娩过程中 D-二聚体发生了大幅度的变化，产后第 l 天急剧升高，至产后第2天明显下降，基本恢复至妊娠末期水平。产后第1天及产后第2天参考区间分别为＜11．76 mg/L、＜5．87 mg/L。5组间 D-二聚体水平差异有统计学意义（P ＜0．001）。正常对照组和孕妇组 D-二聚体浓度低于排除 DVT 临界值（0．5 mg/L）的比例分别为92．3％、55．1％、7．0％、1．0％、0．2％和0．7％。采用上述参考区间评估18例产后发生 DIC 或静脉血栓孕产妇的 D-二聚体水平，均为阳性结果。结论初步建立本实验室正常孕妇血浆 D-二聚体参考区间，妊娠中后期 D-二聚体已不具备特异性，不能作为排除诊断依据。
목적：탐토정상잉부혈장D-이취체적변화특점，건립본실험실정상잉부혈장D-이취체적삼고구간。방법선취정상잉부664례、비잉정상녀성대조자100명（정상대조조），산후발생미산성혈관내응혈（DIC）혹정맥혈전환자18례。장정상잉산부안잉주분위5조：（1）잉＜20주（127례）；（2）잉20～32주（86례）；（3）잉32주지임산≥32주（191례）；（4）산후제1천（130례）；（5）산후제2천（130례）。채용 SYSMEX CA7000전자동응혈의검측소유정상잉부급정상대조조혈장 D-이취체농도，학정상응적삼고구간。잉부 D-이취체농도정편태분포，채용백분위수（P95）표시삼고구간적단측상한。채용건립적삼고구간평고18례산후발생 DIC 혹정맥혈전잉산부적 D-이취체수평，험증해삼고구간적유효성。결과D-이취체수착임신기적연장축점승고，종20주개시지32주축점상승，32주이후승고폭도최대，잉＜20주조、잉20～32주조급잉≥32주조 D-이취체삼고구간분별위＜1．54 mg/L、＜3．46 mg/L급＜4．96 mg/L ；분면과정중 D-이취체발생료대폭도적변화，산후제 l 천급극승고，지산후제2천명현하강，기본회복지임신말기수평。산후제1천급산후제2천삼고구간분별위＜11．76 mg/L、＜5．87 mg/L。5조간 D-이취체수평차이유통계학의의（P ＜0．001）。정상대조조화잉부조 D-이취체농도저우배제 DVT 림계치（0．5 mg/L）적비례분별위92．3％、55．1％、7．0％、1．0％、0．2％화0．7％。채용상술삼고구간평고18례산후발생 DIC 혹정맥혈전잉산부적 D-이취체수평，균위양성결과。결론초보건립본실험실정상잉부혈장 D-이취체삼고구간，임신중후기 D-이취체이불구비특이성，불능작위배제진단의거。
Objective To investigate the change characteristics of plasma D-dimer in healthy pregnant women and establish the reference range.Methods A total of 664 healthy pregnant women and 1 00 healthy women without pregnancy as control group were enrolled,and there were 1 8 cases of disseminated intravascular coagulation (DIC)or venous thrombosis after delivery.They were classified into 5 groups,pregnancy <20 weeks (1 27 cases),pregnancy 20-32 weeks (86 cases),pregnancy ≥32 weeks (1 91 cases),the first postpartum day (1 30 cases)and the second postpartum day (1 30 cases).D-dimer concentration was determined by SYSMEX CA7000 automatic coagulation analyzer in order to identify the reference range.Since D-dimer concentration showed non-normal distribution,the normal values were established by percentile (P95).The results of the 1 8 cases of DIC or venous thrombosis were used to validate the established normal values.Results D-dimer concentration increased continually with pregnancy from 20 weeks to 32 weeks,especially after 32 weeks.The reference ranges were <1 .54 mg/L, <3.46 mg/L and <4.96 mg/L for pregnancy <20 weeks,20-32 weeks and ≥ 32 weeks.D-dimer had a significant change during childbirth,and there was a sharp increasing in the first postpartum day and a significant decline in the second postpartum day recovering to the levels of late pregnancy,which the reference ranges were <1 1 .76 mg/L and <5.87 mg/L,respectively.All groups had statistical significance for D-dimer concentration (P <0.001 ).The percentages of D-dimer which were lower than conventional critical value to exclude DVT (0.5 mg/L)were 92.3%,55.1 %,7.0%, 1 .0%,0.2% and 0.7% in control group and 5 groups in pregnancy,respectively.All the 1 8 cases of DIC or venous thrombosis showed positive results by the above normal values.Conclusions By analyzing the change characteristics of D-dimer in healthy pregnant women,D-dimer reference ranges in healthy pregnant women are established.The D-dimer in middle and late pregnancy is not specific,which can not be as exclusion parameter.