妊娠不同时期血清D-二聚体、孕酮、β-hCG水平对不良妊娠结局的预测价值
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摘要
目的探讨妊娠不同时期血清D-二聚体、孕酮、β-hCG水平对不良妊娠结局的预测价值。方法选取188例高危妊娠孕产妇为研究对象,采集孕11周～12周,孕27周～28周及孕37周的空腹肘静脉血,ELISA实验检测血D-二聚体、孕酮、β-hCG水平,并记录孕产妇妊娠结局,ROC曲线分析各时间点D-二聚体、孕酮、β-hCG水平对不良妊娠结局的预测价值。结果本组孕产妇共发生不良妊娠结局43例(22.87%),最常见不良妊娠结局为早产和宫内窘迫。不良妊娠结局孕产妇的血孕酮和β-hCG水平在各时间点低于正常妊娠结局孕产妇,D-二聚体水平在各时间点高于正常妊娠孕产妇,组间差异有统计学意义(P<0.05)。ROC曲线分析结果显示孕11周～12周、27周～28周、37周血清D-二聚体、孕酮、β-hCG水平预测不良妊娠结局的曲线下面积(AUC)为0.711～0.912。结论妊娠不同时期联检血清D-二聚体、孕酮、β-hCG水平对不良妊娠结局均有较好的预测价值。
Objective To explore the prediction value of plasma D-dimer, progesterone and β-hCG levels in different pregnancy stages for adverse pregnancy outcome, so as to provide data support to improve the pregnancy outcome. Methods Totally 188 high-risk pregnant women were selected as study objects. The fast blood of patients in 11-12 weeks' gestational age, 27-28 gestational age and 37 weeks' gestational age were extracted. D-dimer, progesterone and β-hCG levels were detected by ELISA kits. The pregnancy outcomes were recorded, and the predictive value of D-dimer, progesterone and glycaene-hcg levels at each time point for adverse pregnancy outcomes were analyzed by ROC curve. Results There were 43 cases(22.87%) with adverse pregnancy outcomes in all, and the most common adverse pregnancy outcomes were premature birth and intrauterine distress. D-dimer, progesterone and β-hCG levels of patients with adverse pregnancy outcomes were all higher than those without adverse pregnancy outcomes at each time points, and the differences between groups were statistically significant(P<0.05). ROC curve analysis results showed that the area under the curve(AUC) of D-dimer, progesterone and β-hCG in 11-12 weeks' gestational age, 27-28 gestational age and 37 weeks' gestational age to predict adverse pregnancy outcomes was 0.711-0.912. Conclusion Plasma levels of d-dimer, progesterone, and caurine hCG in different pregnancy stages have good predictive value for adverse pregnancy outcomes, early combined testing is beneficial for early diagnosis and treatment, and dynamic monitoring is beneficial for understanding health condition.
Objective To explore the prediction value of plasma D-dimer, progesterone and β-hCG levels in different pregnancy stages for adverse pregnancy outcome, so as to provide data support to improve the pregnancy outcome. Methods Totally 188 high-risk pregnant women were selected as study objects. The fast blood of patients in 11-12 weeks' gestational age, 27-28 gestational age and 37 weeks' gestational age were extracted. D-dimer, progesterone and β-hCG levels were detected by ELISA kits. The pregnancy outcomes were recorded, and the predictive value of D-dimer, progesterone and glycaene-hcg levels at each time point for adverse pregnancy outcomes were analyzed by ROC curve. Results There were 43 cases(22.87%) with adverse pregnancy outcomes in all, and the most common adverse pregnancy outcomes were premature birth and intrauterine distress. D-dimer, progesterone and β-hCG levels of patients with adverse pregnancy outcomes were all higher than those without adverse pregnancy outcomes at each time points, and the differences between groups were statistically significant(P<0.05). ROC curve analysis results showed that the area under the curve(AUC) of D-dimer, progesterone and β-hCG in 11-12 weeks' gestational age, 27-28 gestational age and 37 weeks' gestational age to predict adverse pregnancy outcomes was 0.711-0.912. Conclusion Plasma levels of d-dimer, progesterone, and caurine hCG in different pregnancy stages have good predictive value for adverse pregnancy outcomes, early combined testing is beneficial for early diagnosis and treatment, and dynamic monitoring is beneficial for understanding health condition.
引文
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[3] 贾亚楠,白华,李明静,等.血清β-人绒毛膜促性激素与孕酮动态监测对早孕期先兆流产的预测价值[J].药物评价研究,2015,38(4):402-404.
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[9] 唐熟能,吴长蓉.早孕期联合测定孕酮、β-hCG及甲状腺激素水平的意义[J].黑龙江医药科学,2018,41(1):176-177,179.
[10] Xin H,Liu W,Li P.Diagnostic value of detection of serum β-hCG and CT-IgG combined with transvaginal ultrasonography in early tubal pregnancy[J].Exp Ther Med,2018,16(1):277-281.
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[12] 黄予.血清孕酮与β-hCG联合检测在先兆流产中的早期预测作用探析[J].中国卫生产业,2014,11(27):135-136.
[13] 宋涛,张平安.妊娠相关性蛋白A、超敏C反应蛋白及D-二聚体用于早期诊断急性冠脉综合征[J].微循环学杂志,2018,28(2):50-53.
[14] 景阳,丁萌,肖艳平,等.妊娠相关静脉血栓栓塞症的D-二聚体变化特征及临界值研究[J].血栓与止血学,2018,24(1):51-53.
[15] 刘道彦,李洪春,石祥奎,等.正常妊娠孕妇不同孕期血浆中D-二聚体含量变化对凝血和纤溶系统的影响[J].抗感染药学,2017,14(3):552-554.
[16] 赵爱学.不同妊娠时期的孕妇血浆D-二聚体和凝血四项的特点[J].临床医学研究与实践,2018,3(10):111-112,119.
[17] 樊秀敏,张帆.联合检测Hcy、叶酸和凝血功能指标对预测先兆流产和妊娠结局的价值[J].中国卫生工程学,2017,16(3):347-349.
[2] 朱仁祝,陈爱娥,俞如葵,等.强化高危妊娠管理对妊娠结局及新生儿的影响[J].江苏医药,2018,44(2):224-225.
[3] 贾亚楠,白华,李明静,等.血清β-人绒毛膜促性激素与孕酮动态监测对早孕期先兆流产的预测价值[J].药物评价研究,2015,38(4):402-404.
[4] 胡振仪,王世帅.高危孕产妇孕期专项管理办法及效果评价[J].中国医院统计,2018,25(1):67-69.
[5] 王丽丽.产前检查的次数及健康教育与产妇妊娠结局的相关性分析[J].中国妇幼保健,2017,32(23):5890-5892.
[6] 张文瑾,解晶,魏若菡,等.早期妊娠伴低血清孕酮者的孕激素治疗研究[J].中国卫生检验杂志,2016,26(4):536-538.
[7] de Ziegler D,Pirtea P,Andersen CY,et al.Role of gonadotropin-releasing hormone agonists,human chorionic gonadotropin (hCG),progesterone,and estrogen in luteal phase support after hCG triggering,and when in pregnancy hormonal support can be stopped[J].Fertil Steril,2018,109(5):749-755.
[8] Shapiro DB,Pappadakis JA,Ellsworth NM,et al.Progesterone replacement with vaginal gel versus i.m.injection:cycle and pregnancy outcomes in IVF patients receiving vitrified blastocysts[J].Hum Reprod,2014,29(8):1706-1711.
[9] 唐熟能,吴长蓉.早孕期联合测定孕酮、β-hCG及甲状腺激素水平的意义[J].黑龙江医药科学,2018,41(1):176-177,179.
[10] Xin H,Liu W,Li P.Diagnostic value of detection of serum β-hCG and CT-IgG combined with transvaginal ultrasonography in early tubal pregnancy[J].Exp Ther Med,2018,16(1):277-281.
[11] 谢雅贞.补肾宁心方对早期先兆流产孕囊周围暗区、血β-hCG、P的影响[J].中医药临床杂志,2017,29(8):1279-1281.
[12] 黄予.血清孕酮与β-hCG联合检测在先兆流产中的早期预测作用探析[J].中国卫生产业,2014,11(27):135-136.
[13] 宋涛,张平安.妊娠相关性蛋白A、超敏C反应蛋白及D-二聚体用于早期诊断急性冠脉综合征[J].微循环学杂志,2018,28(2):50-53.
[14] 景阳,丁萌,肖艳平,等.妊娠相关静脉血栓栓塞症的D-二聚体变化特征及临界值研究[J].血栓与止血学,2018,24(1):51-53.
[15] 刘道彦,李洪春,石祥奎,等.正常妊娠孕妇不同孕期血浆中D-二聚体含量变化对凝血和纤溶系统的影响[J].抗感染药学,2017,14(3):552-554.
[16] 赵爱学.不同妊娠时期的孕妇血浆D-二聚体和凝血四项的特点[J].临床医学研究与实践,2018,3(10):111-112,119.
[17] 樊秀敏,张帆.联合检测Hcy、叶酸和凝血功能指标对预测先兆流产和妊娠结局的价值[J].中国卫生工程学,2017,16(3):347-349.