Zhang Q D, Wei Y M, Liu C, Qiao W R, Gu Y Y, Zhao H X, Yang Huixia
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing 100034, China.
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China.
Zhonghua Fu Chan Ke Za Zhi. 2022 Oct 25;57(10):740-745. doi: 10.3760/cma.j.cn112141-20220331-00204.
To explore and compare the reference ranges of four coagulation tests in normal pregnant women during early and late pregnancy and the influence of age. Values of four coagulation tests from 4 974 pregnant women, who gave single birth at Peking University First Hospital, Obstetrics and Gynecology Hospital of Fudan University, West China Second University Hospital, Peking University Third Hospital and Shengjing Hospital of China Medical University from February 2017 to July 2020, were measured and analyzed in this study, including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib) and thrombin time (TT). The four normal reference ranges of coagulation during early and late pregnancy phases were expressed as -. The difference of two pregnancy phases was compared by non-parametric test of two related samples. And the difference between pregnant women of advanced and non-advanced age in the same pregnancy phase was compared by independent sample non-parametric test. Chi-square test was used to compare the incidence of pregnancy complications in different coagulation reference ranges. The reference ranges of PT of normal pregnant women's early and late pregnancy were 10.0-13.9 s and 9.6-12.3 s, the reference ranges of APTT were 22.6-35.3 s and 22.4-30.9 s, the reference ranges of Fib were 2.4-5.0 g/L and 3.0-5.7 g/L, the reference ranges of TT were 12.0-19.0 s and 11.5-18.4 s. Compared with early pregnancy, PT, APTT and TT shortened significantly, while the Fib significantly increased in late pregnancy (all <0.001). PT, APTT and TT of advanced and non-advanced age pregnant women were significantly different (all <0.01). Compared with the ranges of non-pregnant population, more pregnant women were included in the normal pregnant reference ranges of PT in early pregnancy and APTT in the early and late pregnancy, while the incidence of pregnancy complications had no significant differences (all >0.05). The incidence of fetal distress was higher and the incidence of preterm birth was lower in the reference range of PT in late pregnancy. The incidence of gestational diabetes mellitus was higher in the early and late gestational Fib reference ranges, and the incidence of hypertensive disorders in pregnancy was higher in the late gestational Fib reference range (all <0.05). The coagulation function of pregnant women increases significantly with the growth of pregnancy, and there is a significant difference between advanced significantly and non-advanced age pregnant women. The recommended ranges of normal pregnant women's early and late pregnancy PT are 10.0-13.9 s and 9.6-12.3 s, the recommended ranges of APTT are 22.6-35.3 s and 22.4-30.9 s, the recommended ranges of TT are 12.0-19.0 s and 11.5-18.4 s. The appropriate ranges of normal pregnant women's early and late pregnancy Fib still need further exploration.
探讨并比较正常孕妇早孕期和晚孕期四项凝血指标的参考范围以及年龄的影响。本研究对2017年2月至2020年7月在北京大学第一医院、复旦大学附属妇产科医院、四川大学华西第二医院、北京大学第三医院和中国医科大学附属盛京医院单胎分娩的4974例孕妇的四项凝血指标进行了检测和分析，包括凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（Fib）和凝血酶时间（TT）。早孕期和晚孕期四项凝血指标的正常参考范围表示为-。采用两相关样本非参数检验比较两个孕期的差异。采用独立样本非参数检验比较同孕期高龄和非高龄孕妇之间的差异。采用卡方检验比较不同凝血参考范围内妊娠并发症的发生率。正常孕妇早孕期和晚孕期PT的参考范围分别为10.0 - 13.9秒和9.6 - 12.3秒，APTT的参考范围分别为22.6 - 35.3秒和22.4 - 30.9秒，Fib的参考范围分别为2.4 - 5.0克/升和3.0 - 5.7克/升，TT的参考范围分别为12.0 - 19.0秒和11.5 - 18.4秒。与早孕期相比，晚孕期PT、APTT和TT显著缩短，而Fib显著升高（均P<0.001）。高龄和非高龄孕妇的PT、APTT和TT有显著差异（均P<0.01）。与非妊娠人群范围相比，早孕期PT和早、晚孕期APTT的正常孕妇参考范围内纳入的孕妇更多，而妊娠并发症的发生率无显著差异（均P>0.05）。晚孕期PT参考范围内胎儿窘迫发生率较高，早产发生率较低。早、晚孕期Fib参考范围内妊娠期糖尿病发生率较高，晚孕期Fib参考范围内妊娠期高血压疾病发生率较高（均P<0.05）。孕妇凝血功能随孕周增加显著增强，高龄和非高龄孕妇之间有显著差异。正常孕妇早孕期和晚孕期PT的推荐范围分别为10.0 - 13.9秒和9.6 - 12.3秒，APTT的推荐范围分别为22.6 - 35.3秒和22.4 - 30.9秒，TT的推荐范围分别为12.0 - 19.0秒和11.5 - 18.4秒。正常孕妇早孕期和晚孕期Fib的适宜范围仍需进一步探索。
