不同流产次数复发性流产患者血小板聚集率、D-二聚体水平变化分析

doi:10.3969/j.issn.1673-8640.2025.03.016

摘要/Abstract

摘要：

目的分析不同流产次数复发性流产患者血小板聚集率（PAgT）、D-二聚体（DD）水平变化，为早期预测和治疗再次流产提供参考。方法选取2020年7月—2023年8月长治市人民医院143例有复发性流产史的孕妇，按照流产次数分为≥3次组和2次组，根据最终妊娠结局分为再次流产组和未流产组。检测所有孕妇早孕期PAgT、DD和凝血功能指标[纤维蛋白原（Fib）、凝血酶时间（TT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）]；采用Pearson相关分析评价复发性流产患者PAgT、DD水平与凝血功能指标的相关性；采用Logistic回归分析评估复发性流产患者流产次数≥3次的影响因素；采用受试者工作特征（ROC）曲线评价PAgT、DD判断复发性流产患者再次流产的效能。结果 ≥3次组花生四烯酸（AA）诱导PAgT、腺苷二磷酸（ADP）诱导PAgT、DD、Fib均高于2次组，TT、PT、APTT低于2次组（P<0.001）。复发性流产患者AA诱导PAgT、ADP诱导PAgT、DD与Fib均呈正相关，与TT、PT、APTT均呈负相关（P<0.001）。AA诱导PAgT、ADP诱导PAgT、DD是复发性流产患者流产次数≥3次的独立危险因素[比值比（OR）值分别为2.984、2.913、2.850，95%可信区间（CI）分别为1.572~5.664、1.551~5.617、1.464~5.550，P<0.05]。再次流产组AA诱导PAgT、ADP诱导PAgT、DD水平均高于未流产组（P<0.001）。AA诱导PAgT、ADP诱导PAgT、DD预测复发性流产患者再次流产的最佳临界值分别为87.42%、85.46%、415.13 μg·L^-1。结论流产次数≥3次的复发性流产患者AA诱导PAgT、ADP诱导PAgT、DD水平较高，各指标联合检测对复发性流产患者再孕后流产具有一定的预测价值。

关键词: 血小板聚集率, D-二聚体, 复发性流产, 流产次数

Abstract:

Objective To analyze the changes in platelet aggregation rate （PAgT） and D-dimer （D-D） level in recurrent abortion patients with different times，and to provide a reference for early prediction and treatment of recurrent abortion. Methods From July 2020 to August 2023，143 patients with recurrent abortion who were treated in Changzhi People's Hospital were enrolled. They were classified into abortion≥3 time group and 2 time group，which were classified into 2 groups based on their final pregnancy outcome，recurrent abortion group and non-abortion group. PAgT，DD and coagulation function indicators such as fibrinogen （Fib），thrombin time （TT），prothrombin time （PT） and activated partial thromboplastin time （APTT） were determined. The correlation between PAgT，DD level and coagulation function indicators in patients with recurrent abortion was analyzed using Pearson method. The influencing factors of recurrent abortion patients with abortion≥3 times were analyzed using Logistic regression analysis. The predictive value of PAgT and DD level for recurrent abortion was analyzed using receiver operating characteristic （ROC） curve. Results Arachidonic acid （AA） induced PAgT，adenosine diphosphate （ADP） induced PAgT，DD，Fib in≥3 time group were higher than those in 2 time group，while TT，PT，APTT were lower than those in 2 time group （P<0.001）. The levels of AA induced PAgT，ADP induced PAgT，DD in patients with recurrent abortion were positively correlated with Fib，and they were negatively correlated with TT，PT and APTT（P<0.001）. AA induced PAgT，ADP induced PAgT，DD were independent risk factors for recurrent abortion patients with abortion≥3 times [odds ratios（OR）were 2.984，2.913 and 2.850，95% confidence intervals（CI） were 1.572-5.614，1.551-5.617 and 1.464-5.550，P<0.05）. The levels of AA induced PAgT，ADP induced PAgT and DD in recurrent abortion group were higher than those in non-abortion group （P<0.05）. The optimal cut-off values of AA induced PAgT，ADP induced PAgT and DD level in predicting recurrent abortion were 87.42%，85.46% and 415.13 μg·L^-1， respectively. Conclusions Patients with recurrent abortion≥3 times have higher AA induced PAgT，ADP induced PAgT and DD level，and the combined determination of various indicators has certain predictive value for recurrent abortion after re-pregnancy in patients with recurrent abortion.

Key words: Platelet aggregation rate, D-dimer, Recurrent abortion, Abortion frequency

中图分类号:

R446.1

李越, 李莉, 杨晨. 不同流产次数复发性流产患者血小板聚集率、D-二聚体水平变化分析[J]. 检验医学, 2025, 40(3): 294-298.

LI Yue, LI Li, YANG Chen. Analysis of changes in platelet aggregation rate and D-dimer level in recurrent abortion patients with different times[J]. Laboratory Medicine, 2025, 40(3): 294-298.

图/表 7

参考文献 23

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组别	例数	年龄/岁	孕前体重指数/（kg·m^-2）	孕周/周	最终妊娠结局		Fib/ （g·L^-1）	TT/s	PT/s	APTT/s
组别	例数	年龄/岁	孕前体重指数/（kg·m^-2）	孕周/周	未流产/ [例（%）]	再次流产/[例（%）]	Fib/ （g·L^-1）	TT/s	PT/s	APTT/s
2次组	56	27.34±2.06	22.62±2.78	8.45±1.40	17（30.36）	39（69.64）	1.58±0.45	20.90±2.35	12.98±1.41	25.95±2.76
≥3次组	87	27.23±2.35	22.58±3.07	8.48±1.45	24（27.59）	63（72.41）	2.86±0.82	16.27±1.46	10.76±0.83	21.40±1.80
统计值		0.286	0.079	0.122	0.128		10.683	14.541	11.850	11.940
P值		0.775	0.937	0.903	0.721		<0.001	<0.001	<0.001	<0.001

组别	例数	年龄/岁	孕前体重指数/（kg·m^-2）	孕周/周	最终妊娠结局		Fib/ （g·L^-1）	TT/s	PT/s	APTT/s
组别	例数	年龄/岁	孕前体重指数/（kg·m^-2）	孕周/周	未流产/ [例（%）]	再次流产/[例（%）]	Fib/ （g·L^-1）	TT/s	PT/s	APTT/s
2次组	56	27.34±2.06	22.62±2.78	8.45±1.40	17（30.36）	39（69.64）	1.58±0.45	20.90±2.35	12.98±1.41	25.95±2.76
≥3次组	87	27.23±2.35	22.58±3.07	8.48±1.45	24（27.59）	63（72.41）	2.86±0.82	16.27±1.46	10.76±0.83	21.40±1.80
统计值		0.286	0.079	0.122	0.128		10.683	14.541	11.850	11.940
P值		0.775	0.937	0.903	0.721		<0.001	<0.001	<0.001	<0.001

组别	例数	AA诱导PAgT/%	ADP诱导PAgT/%	DD/ （μg·L^-1）
2次组	56	81.26±7.42	80.75±6.24	395.57±54.22
≥3次组	87	92.54±5.13	93.45±4.97	492.74±85.63
t值		10.748	13.477	7.566
P值		<0.001	<0.001	<0.001

组别	例数	AA诱导PAgT/%	ADP诱导PAgT/%	DD/ （μg·L^-1）
2次组	56	81.26±7.42	80.75±6.24	395.57±54.22
≥3次组	87	92.54±5.13	93.45±4.97	492.74±85.63
t值		10.748	13.477	7.566
P值		<0.001	<0.001	<0.001

项目	β值	标准误	Wald值	OR值（95%CI）	P值
AA诱导PAgT	1.093	0.327	11.178	2.984（1.572~5.664）	0.001
ADP诱导PAgT	1.069	0.335	10.186	2.913（1.511~5.617）	0.001
DD	1.047	0.340	9.489	2.850（1.464~5.550）	0.002
Fib	0.017	0.132	0.016	1.017（0.785~1.317）	0.898
TT	0.002	0.074	0.001	1.002（0.867~1.158）	0.978
PT	0.170	0.154	1.215	1.185（0.876~1.603）	0.270
APTT	0.130	0.128	1.034	1.139（0.886~1.464）	0.309