[1]董 峰,吕忠兴,邸 平.妊娠期糖尿病患者血浆FM，D-Dimer 和FIB 检测评价不同治疗方案对凝血功能及不良妊娠结局的影响[J].现代检验医学杂志,2023,38(03):195-198+203.[doi:10.3969/j.issn.1671-7414.2023.03.036]
　DONG Feng,L? Zhong-xing,DI Ping.Evaluate the Effects of Different Treatment Schemes on Coagulation Function and Adverse Pregnancy Outcomes with Fibrin Monomer, D-Dimer and FIB in Patients with Gestational Diabetes Mellitus[J].Journal of Modern Laboratory Medicine,2023,38(03):195-198+203.[doi:10.3969/j.issn.1671-7414.2023.03.036]
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妊娠期糖尿病患者血浆FM，D-Dimer 和FIB 检测评价不同治疗方案对凝血功能及不良妊娠结局的影响()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第38卷
期数:
2023年03期
页码:
195-198+203
栏目:
检验与临床
出版日期:
2023-05-15

文章信息/Info

Title:
Evaluate the Effects of Different Treatment Schemes on Coagulation Function and Adverse Pregnancy Outcomes with Fibrin Monomer, D-Dimer and FIB in Patients with Gestational Diabetes Mellitus
文章编号:
1671-7414（2023）03-195-05
作者:
董 峰1; 吕忠兴2; 邸 平3
（1. 北京积水潭医院检验科，北京100035；2. 郑州大学第三附属医院检验科，郑州450052；3. 中国人民解放军总医院第一医学中心医学检验科，北京100853）
Author(s):
DONG Feng1;  L? Zhong-xing2;  DI Ping3
（1. Department of Medical Laboratory Center, Beijing Jishuitan Hospital， Beijing 100035, China; 2. Department of Medical Laboratory Center, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; 3. Department of Medical Laboratory
关键词:
妊娠期糖尿病; 胰岛素; 妊娠结局; 血液凝固; 纤维蛋白单体
分类号:
R714.256；R446.11
DOI:
10.3969/j.issn.1671-7414.2023.03.036
文献标志码:
A
摘要:
目的 探讨纤维蛋白单体（FM）、D- 二聚体（D-Dimer）以及纤维蛋白原定量（FIB）等凝血指标与妊娠期糖尿病(GDM) 患者不同治疗方案和不良妊娠结局的关系。方法 选取2021 年6 月～ 2022 年1 月在解放军总医院产科门诊就诊的正常孕晚期女性为正常妊娠组（n=40）和GDM 患者（n=74），其中50 例通过饮食和运动控制血糖（GDM非药物组），24 例使用胰岛素控制血糖（GDM 胰岛素组）。采用单因素方差分析和Kruskal-Wallis H 检验比较三组患者研究指标的差异，采用LSD-t 检验和Bonferroni 校正进行两两比较；并观察不良妊娠结局患者凝血特征。结果 正常妊娠组、GDM 非药物组和GDM 胰岛素组患者凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）和凝血酶时间（TT）比较差异均无统计学意义（F=1.051，H=4.368，F=0.021，均P>0.05）；FIB（4.24±0.66 g/L，4.57±0.71 g/L，4.22±0.58 g/L）， D-Dimer[0.32(0.30，0.45）mg/L，0.49（0.32，0.73）mg/L, 0.34（0.21，0.45）mg/L]，FM [3.44(2.82，5.08）mg/L，4.53（3.44，12.99）mg/L，4.61（4.10，6.23）mg/L] 比较，差异均有统计学意义(F=3.847，H=9.194，8.968，均P<0.05)。两两比较显示，正常妊娠组FIB 和FM 水平低于GDM 非药物组（t=2.429, U=2.627 , 均P<0.05），GDM 胰岛素组FIB 和 D-Dimer 水平低于GDM 非药物组（t=2.102，U=2.665，均P<0.05），差异均有统计学意义。正常妊娠组、GDM 非药物组和GDM 胰岛素组患者FM 正常率（FM ≤ 6.0 mg/L）分别为80.00%，60.00% 和78.30%；高血栓发生风险率（FM ≥ 35 mg/L）分别为7.50%，12.00% 和4.17%； D-Dimer 正常率（D-Dimer<0.23 mg/L）分别为12.50%，6.00%和20.83%。临床结局方面，出现不良妊娠结局患者FM 和 D-Dimer 均高于血栓风险界值。结论 FM， D-Dimer 和FIB联合使用可有效反映GDM 患者不同治疗方案下凝血功能的差异，具备预测不良妊娠事件的潜力，且FM 作为孕期血栓风险标志物的临床价值优于 D-Dimer。
Abstract:
Objective To explore the relationship between fibrin monomer (FM) , D-Dimer, Fibrinogen（FIB） and othercoagulation index among different treatment schemes and adverse pregnancy outcomes in patients with Gestational Diabetes Mellitus (GDM). Methods From June 2021 to January 2022，a total of 114 women from the Obstetric Clinic of PLA General Hospital were selected as study subjects, including 40 women with normal pregnancy in the third trimester(normal pregnancy group), 50 patients control their blood glucose through diet and exercise (GDM-non-drug group)，and 24 patients control their blood glucose with insulin (GDM-insulin group). One-way ANOVA and Kruskal-Wallis H tests were used to compare the differences of research indicators among the three groups. Furthermore, LSD-t test and Bonferroni correction for pairwise comparison were counted. The coagulation characteristics of patients with adverse pregnancy outcomes were observed. Results There was no statistically significant difference in prothrombin time (PT), thrombin time (TT) and activated partial thromboplastin time (APTT) among the normal pregnancy group, GDM non-drug group and GDM insulin group（F=1.051，H=4.368，F=0.021, all P>0.05）. However, FIB（4.24±0.66 g/L, 4.57±0.71 g/L, 4.22±0.58g/L）, D-Dimer [ 0.32(0.30, 0.45） mg/L, 0.49（0.32, 0.73）mg/L, 0.34（0.21, 0.45）mg/L] and FM [3.44(2.82, 5.08）mg/L, 4.53（3.44, 12.99）mg/L, 4.61（4.10, 6.23）mg/L], the differences were statistically significant (F=3.847, H=9.194, 8.968, all P<0.05). The pairwise comparison showed that FIB and FM in the normal pregnancy group were lower than those in the GDM-non-drug group (t=2.429, U=2.627, all P<0.05), FIB and DD in GDM-insulin group were lower than those in GDM-non-drug group (t=2.102, U=2.665, all P<0.05) , and the differences were statistically significant, respectively. Among normal pregnancy group, GDM-non-drug group and GDMinsulin group, the rates of normal FM（FM≤ 6.0 mg/L）were 80.00%，60.00% and 78.30%, the high risk of thrombosis（FM≥ 35 mg/L）were 7.50%，12.00% and 4.17%, and the normal rates of D-Dimer（ D-Dimer<0.23 mg/L）were 12.50%，6.00% and 20.83%, respectively. In terms of clinical outcomes, FM and D-Dimer displayed the higher levels than the respective thrombosis threshold values in patients with adverse pregnancy outcomes. Conclusion FM combined with D-Dimer and FIB could effectively reflect the difference of coagulation function of GDM patients under different treatment schemes, and has the potential to predict adverse pregnancy events. The clinical value of FM as a risk marker of pregnancy thrombosis is better than D-Dimer.

参考文献/References:

[1] American Diabetes Association Professional Practice Committee. 15. Management of diabetes in pregnancy: standards of medical care in diabetes-2022[J]. Diabetes Care, 2022, 45(Suppl 1): S232-S243.
[2] YE Wenrui, LUO Cong, HUANG Jing, et al. Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis[J]. BMJ, 2022, 377: e067946.
[3] HU Zhiying, TIAN Yaping, LI Jia, et al. Coagulation index and pregnancy outcome in gestational diabetes mellitus[J]. Clinical Laboratory, 2021, 67(1): 48-54.
[4] KRISTOFFERSEN A H, PETERSEN P H, BJ?RGE L, et al. Concentration of fibrin monomer in pregnancy and during the postpartum period[J]. Annals of Clinical Biochemistry, 2019, 56(6): 692-700.
[5] SEKIYA A, HAYASHI T, KADOHIRA Y, et al. Thrombosis prediction based on reference ranges of coagulation-related markers in different stages of pregnancy[J]. Clinical and Applied Thrombosis/ Hemostasis, 2017, 23(7): 844-850.
[6] LI Xiaoling, WEBER N C, COHN D M, et al. Effects of hyperglycemia and diabetes mellitus on coagulation and hemostasis[J]. Journal of Clinical Medicine, 2021,10(11): 2419.
[7] American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2019[J]. Diabetes Care, 2019, 42(Suppl 1): S13-S28.

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备注/Memo

备注/Memo:
基金项目：北京积水潭科研基金【QN202217】。
作者简介：董峰（1988-），女，博士（在读），主管技师，研究方向：炎症与凝血， E-mail：dongfeng301@foxmail.com。
通讯作者：邸平（1981-），女，硕士，副主任技师，研究方向：出凝血疾病的实验诊断， E-mail：xdd_0609@163.com。
更新日期/Last Update: 2023-05-15