生殖医学杂志2018，Vol.27Issue(4)：339-344,6.DOI:10.3969/j.issn.1004-3845.2018.04.009
D-二聚体在孕早期不明原因复发性流产患者中临界值的探讨
Cutoff value of D-dimer in patients with unexplained recurrent spontaneous abortion during early pregnancy
摘要
Abstract
Objective:To investigate the cutoff value of D-dimer in the patients with unexplained recurrent spontaneous abortion(URSA)during early pregnancy.Methods:A total of 2 975 patients were enrolled in the study in Department of Obstetrician and Gynecologist of People's Hospital of Wenzhou.The patients were divided into 3 groups:the early pregnancy patients without abortion history who underwent abortion were included in the outpatient clinic in NEP group(n=1 160);the patients with ≥2 times missed abortion history who had early intrauterine single pregnancy were included in AEP group(n =673);the patients with missed abortion history and without pregnancy were included in ANP group(n=1 142).All patients underwent D-dimer level testing.The patients in AEP and NEP group also had the test of blood homocysteine(Hcy),activated protein C resistance(APC R),prothrombin PT,and partial thromboplastin time(APTT).The differences of various indicators were analyzed by using GraphPad 6.0 among the groups.The area under the receiver operating characteristic curve(ROC),i,e.AUC,was used to calculate the cutoff value.The cutoff values of D dimer and other indicators were calculated in the pregnancy patients with unexplained recurrent abortion.Results:There was no significant difference in age,body mass index(BMI),gravidity,basic levels of FSH and anti-Mullerian hormone(AMH)among the three groups(P＞ 0.05).The cutoff value of D-dimer in three groups was 0.65,0.51and 0.57 mg/L,respectively.The cutoff value of NEP and ANP group was significantly decreased compared with AEP group(P＜0.05).Comparison of indexes in AEP and NEP groups showed that the cutoff value of D-dimer was 0.65 mg/L;the AUC of D-dimer was 0.89,with a positive predictive value of 90.24％ and a negative predictive value of 72.67％;all of the indicators had statistical significance(P＜0.05).The cutoff value of Hcy(9.75 μmol/L)and PT(12.85 s)also had statistical significance(P＜0.05).There were no significant differences in APTT and APC-R among the groups,which had no significant difference in predicting unexplained recurrent abortion.Conclusions:The D-dimer levels in patients with early recurrent abortion significantly increased,and there is a tendency to thrombosis.Detection of D-dimer can predict the possibility of thrombosis in patients with recurrent abortion and improve pregnancy outcomes.关键词
不明原因复发性流产/D-二聚体/血栓前状态/临界值Key words
Unexplained recurrent spontaneous abortion/D-dimer/Prethrombotic state/Cutoff value引用本文复制引用
林涛,沈晓露,潘豪杰,吴雪清..D-二聚体在孕早期不明原因复发性流产患者中临界值的探讨[J].生殖医学杂志,2018,27(4):339-344,6.基金项目
浙江省科技计划项目(2014C33158) （2014C33158）
浙江省医药卫生科技平台青年人才项目(2018RC065) （2018RC065）
