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目的探讨死胎患者分娩前母体D-二聚体水平的变化。方法比较27例死胎患者和293例健康孕妇产前凝血与纤溶检验学指标的差异,分析死胎患者产前D-二聚体浓度与年龄、孕次、产次、孕周、血小板计数、凝血功能、肝脏功能等临床指标的相关性。结果死胎患者的产前母体D-二聚体水平[409(102～18021)μg/L]高于健康孕妇[216(10～850)μg/L](P=0.000),而凝血酶原时间、凝血酶原时间活动度、凝血酶原标准化比值、活化部分凝血酶原时间、纤维蛋白原含量、凝血酶凝结时间与健康孕妇比较无统计学差异(P>0.05)。死胎患者D-二聚体水平与年龄、孕次、产次、孕周、血小板计数、凝血功能(凝血酶原时间、凝血酶原时间活动度、凝血酶原标准化比值、活化部分凝血酶原时间、纤维蛋白原、凝血酶凝结时间)、肝脏功能(白蛋白、球蛋白、谷丙转氨酶、谷草转氨酶、碱性磷酸酶、胆碱酯酶、总胆红素)等18项指标均不相关(r分别为0.114、0.239、0.174、-0.182、-0.268、-0.160、0.267、0.006、-0.131、-0.204、-0.023、-0.277、-0.069、0.165、0.249、-0.041、-0.103、-0.016,P均>0.05)。结论死胎患者分娩前D-二聚体水平升高,母体血液不但呈高凝状态,继发性纤维蛋白溶解也增强。
Objective To investigate the changes of maternal D-dimer before delivery in stillbirth patients. Methods The differences of prenatal coagulation and fibrinolytic assay between 27 stillbirths and 293 healthy pregnant women were analyzed. Prenatal D-dimer concentration, age, gestational age, parity, gestational age, platelet count, coagulation Function, liver function and other clinical indicators related. Results The level of prenatal D-dimer in preterm fetus [409 (102-1801) μg / L] was significantly higher than that in healthy pregnant women [216 (10-850) μg / L] Prothrombin time activity, prothrombin normalized ratio, activated partial prothrombin time, fibrinogen content, thrombin coagulation time compared with healthy pregnant women showed no significant difference (P> 0.05). The level of D-dimer in the stillbirth patients was positively correlated with age, gestational age, parity, gestational age, platelet count, coagulation function (prothrombin time, prothrombin time activity, prothrombin normalization ratio, activated partial prothrombin time , Fibrinogen, thrombin clotting time), liver function (albumin, globulin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, cholinesterase, total bilirubin) and other 18 indicators were not related r were 0.114, 0.229, 0.174, -0.182, -0.268, -0.160, 0.277, 0.006, -0.131, -0.204, -0.023, -0.277, -0.069, 0.165, 0.249, -0.041, -0.103, -0.016, P> 0.05). Conclusion The level of D-dimer before delivery in stillbirth patients increases. The maternal blood not only shows hypercoagulable state, but also enhances the secondary fibrinolysis.