D-二聚体定量测定对妊娠期高血压疾病产后出血的预测价值
摘要：目的探讨D-二聚体定量测定对妊娠期高血压疾病患者产后出血的预测价值。方法选取我院2013年1月至2014年2月收治的150例妊娠期高血压疾病患者进行D-二聚体定量检测分析，单因素方差分析其分娩前24小时内D-二聚体测量值与分娩后24小时内失血量的相关性，以ROC曲线分析其对妊娠期高血压疾病患者产后出血的预测截断值。结果 150例患者分娩前24小时内D-二聚体水平显著升高，并发产后出血28例，发生率18.67%（28/150）。妊娠期高血压疾病并发产后出血组比对照组分娩前24小时内D-二聚体水平显著升高（P＜0.01）。ROC曲线下方面积为O.848，其标准误差为0.042，95％可信区域为0.766—0.930。最佳临界值为2.26mg/L，此时特异度为66.4%，灵敏度为92.9%，youden指数0.593。结论 D-二聚体定量测定对妊娠期高血压疾病产后出血预测有较高价值，以2.26mg/L作为预测截断值最合适。
关键词：D-二聚体;妊娠期高血压疾病;产后出血
Predictive Value of Quantitative Determination of D-dimer on Postpartum Hemorrhage from Hypertensive Disorder in Pregnancy
Abstract
Objective To explore the predictive value of quantitative determination of D-dimer on postpartum hemorrhage from patients with hypertensive disorders in pregnancy. Methods :150 cases of pregnancy-induced hypertension patients who were treated in our hospital from January 2013 to February 2014 were randomly divided into two groups, give them D-dimer detection analysis, and do the single factor analysis of variance between 24 hours before delivery and the two D- dimer measurements and blood loss within 24 hours after delivery quantity .Finally, analyze the prediction of truncated postpartum hemorrhage in patients with hypertension syndrome of pregnancy and its value using ROC curve. Resultsthe two D- dimer levels of the 150 patients 24 hours before delivery were significantly increased.Among them, 28 cases generatedpostpartum hemorrhage, and the incidence was 18.67% (28/150);The treatment group was better than the control in the aspect of 24 hours before delivery D-dimer levels,there was statistical significance(P<0.01) between the two groups.Area under the ROC curve was O.848, and its standard error is 0.042,95% CI 0.766-0.930 region. Best critical value of 2.26mg / L, this time a specificity of 66.4%, a sensitivity of 92.9%, youden index of 0.593. ConclusionQuantitative determination of D-dimer on hypertensive disorders in pregnancy has high value in predicting postpartum hemorrhage, and the most appropriate cutoff value to predict is
2.26mg/L.
Keywords: D-dimer; hypertensive disorders in pregnancy;postpartum hemorrhage
目前国内已有D-二聚体定性检测在妊娠期高血压疾病中意义的报道，暂未见有定量检测在妊娠期高血压疾病产后出血中的预测相关报道。本研究进行D-二聚体定量检测，可对妊娠期高血压疾病患者的血栓前状态和继发性纤溶亢进作出及时评估,预测其并发产后出血发生率，预防或阻止其产后出血的发生,降低产后出血发生率，减少产妇失血，缓解临床用血紧张，节约医疗成本，避免产妇死亡，对挽救家庭幸福、维持社会稳定起着至关重要作用。 1资料与方法
1.1研究对象选取我院2013年1月至2014年2月收治的住院分娩总产妇4916例，其中妊娠期高血压疾病[1]患者150例,占3.05%（150/4916）。患者年龄在21～39岁之间，平均年龄（30.2±3.4）岁，孕周在25～40+周之间，平均孕周为（33.4±3.6）。150例妊娠期高血
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