凝血复合型指标(DFR)对于预测宫腔粘连的 严重程度的价值

The Value of Coagulation Composite Index (DFR) in Predicting the Severity of Intrauterine Adhesion (IUA)

摘要: 目的：探讨D-二聚体与纤维蛋白原比值(DFR)对宫腔粘连(IUA)严重程度的预测价值，为临床术前无创评估提供参考。方法：选取2023年1月至2025年10月于我院行宫腔镜手术确诊的121例IUA患者，依据《宫腔粘连临床诊疗中国专家共识(2015年版)》分为轻度组(37例)、中度组(74例)和重度组(9例)。收集所有患者术前1周内的凝血功能指标，计算DFR值(D-二聚体/纤维蛋白原)，采用Kruskal-Wallis H检验、Mann-Whitney U检验(Bonferroni法校正)分析不同严重程度IUA患者的临床特征及凝血指标差异。结果：三组患者基线人口学及生育相关指标无显著差异(P均>0.05)，宫腔操作次数、操作类型组间差异有统计学意义(P分别为0.013、0.004)；凝血指标中，D-二聚体与DFR水平组间差异显著(P < 0.001)，重度组均显著高于轻、中度组(校正后P均<0.017)，而基础凝血指标组间无显著差异(P均>0.05)。结论：DFR与IUA严重程度显著相关，尤其对重度粘连的识别具有价值，可作为临床术前无创评估IUA严重程度的潜在指标。

Abstract: Objective: To explore the predictive value of the D-dimer to fibrinogen ratio (DFR) for the severity of intrauterine adhesion (IUA), and to provide a reference for non-invasive preoperative clinical evaluation. Methods: A total of 121 patients diagnosed with IUA by hysteroscopic surgery in our hospital from January 2023 to October 2025 were selected. According to the Chinese Experts Consensus on Clinical Diagnosis and Treatment of Intrauterine Adhesion (2015 Edition), the patients were divided into the mild group (37 cases), moderate group (74 cases) and severe group (9 cases). Coagulation function indexes of all patients within 1 week before surgery were collected, and the DFR value (D-dimer/fibrinogen) was calculated. Kruskal-Wallis H test and Mann-Whitney U test (Bonferroni correction) were used to analyze the differences in clinical characteristics and coagulation indexes among patients with different severity of IUA. Results: There were no significant differences in baseline demographic and fertility-related indexes among the three groups (all P > 0.05), while the differences in the number of intrauterine operations and operation types among the groups were statistically significant (P = 0.013 and 0.004, respectively). Among the coagulation indexes, the levels of D-dimer and DFR showed significant differences among the three groups (P < 0.001), and those in the severe group were significantly higher than those in the mild and moderate groups (all corrected P < 0.017), while there were no significant differences in basic coagulation indexes among the groups (all P > 0.05). Conclusion: DFR is significantly correlated with the severity of IUA, especially valuable for identifying severe adhesion, and can be used as a potential index for non-invasive preoperative evaluation of IUA severity.