目的:探讨孕产妇产前凝血四项、D-二聚体(D-D)与血小板参数水平的监测意义。方法:选取广东同江医院2020年1月至2021年6月检查并分娩的454例孕产妇(孕早期96例,孕中期138例,孕晚期114例,临产期106例)为研究对象,另选取妊娠伴其他疾病(妊娠合并糖尿病、高血压等)组60例、产科意外组45例、健康对照组167例(健康育龄期非妊娠妇女)。比较各组D-D、凝血四项指标包括:活化部分凝血活酶时间(activated partial thromboplastin time, APTT)、凝血酶原时间(prothrombin time, PT)、纤维蛋白质原(fibrinogen, FIB)、凝血酶时间(thrombin time, TT);比较各组血小板参数包括:血小板计数(platelet count, PLT)、平均血小板体积(mean platelet volume, MPV)、血小板体积分布宽度(platelet volume distribution width, PDW)。结果:正常妊娠组D-D与FIB指标较妊娠伴其他疾病组与产科意外组明显降低(P＜0.05);正常妊娠组PT指标较妊娠伴其他疾病组与产科意外组明显升高(P＜0.05);正常妊娠组PLT、MPV、PDW指标差异较妊娠伴其他疾病组与产科意外组均明显升高(P＜0.05)。结论:凝血四项指标、D-D以及血小板指标可有效监测孕产妇产前是否处于凝血功能状态,对掌握病情、改善妊娠结局及预防产妇血栓及产后出血方面具有重要意义,临床可推广应用。

Objective: To explore the prognostic significance of D-dimer, routine coagulation tests and platelet parameters in pregnant women. Methods: A total of 454 cases of pregnant women who came to Guangdong Tongjiang Hospital for examination and delivery from January 2020 to June 2021 were selected as the normal pregnancy group (96 cases in the first trimester, 138 cases in the second trimester, 114 cases in the third trimester, and 106 cases in the parturient period), another 60 cases of pregnancy with other diseases such as gestation combining with diabetes or hypertension were selected as the other-disease-combining group, and 45 cases of obstetric accidents were collected as the obstetric accident group. In addition, 167 cases of non-pregnant women in childbearing age who came to our hospital for health examination were selected as the healthy control group. The D-D level and coagulation tests including activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB), and thrombin time (TT) were compared among the four groups. The platelet parameters including platelet count (PLT), mean platelet volume (MPV), and platelet volume distribution width (PDW) were also compared among the four groups. Results: The levels of D-D and FIB in the normal pregnancy group were significantly lower than those in the other-disease-combining group and the obstetric accident group (P＜0.05). PT level in the normal pregnancy group was significantly higher than that in the other-disease-combining group and the obstetric accident group (P＜0.05). The PLT, MPV and PDW levels in the normal pregnancy group were significantly higher than those in the other-disease-combining group and the obstetric accident group (P＜0.05). Conclusion: Four indexes of blood coagulation, D-D and platelet parameters can effectively monitor the state of blood coagulation of pregnant women before delivery, which is of great significance in mastering the coagulation condition, improving the pregnancy outcome and preventing maternal thrombosis or postpartum hemorrhage, it is worthy of popularization and clinical promotion.