孕期D-二聚体国内外研究进展

Global Research Progress on D-Dimer in Pregnancy

摘要: 孕期D-二聚体水平随孕周升高已成共识，但参考区间地域差异非常大，临床解读仍缺少统一标尺，本文系统梳理国内外近十年横断面及纵向研究13项，覆盖中国六大片区、国外各地区，汇总样本逾2万例。结果显示：国内孕早、中期区间相对稳定，孕晚期跃升3~7倍，上限跨度0.00099~0.00503 mg/mL，东西差异达5倍；国外数据虽整体波动幅度相对平缓，孕晚期上限0.0013~0.0028 mg/mL，但国别间水平差异仍可高达两倍。检测体系、人群遗传及膳食铁状态大概是最主要影响因素；在临床应用价值方面，D-二聚体对深静脉血栓诊断相关曲线下面积(AUC)国内0.86~0.90，诊断效能优于国外0.75左右，而在产后出血、子痫前期及胎儿生长受限的预警阈值方面，不同地域人群存在明显差异，在尚无统一标准的前提下，应尽早依据孕周、分娩方法及风险分层制定本土化参考区间，并采用固定检测机构动态监测，从而降低假阳性率、避免过度抗凝，实现妊娠期血栓性疾病的精准防控。

Abstract: It has been agreed that D-dimer level increases with gestational age, but the reference interval varies greatly from region to region, and there is still a lack of unified scale for clinical interpretation. This paper systematically reviewed 13 cross-sectional and longitudinal studies at home and abroad in the past ten years, covering six regions in China and various regions abroad, with more than 20,000 samples. In China, the interval between the first and second trimesters was relatively set, and the third trimester jumped 3~7 times, with the upper limit ranging from 0.00099~0.00503 mg/mL, and the difference between the east and west was 5 times. Although the overall variation in international data is relatively moderate, with third trimester upper limits ranging from 0.0013 to 0.0028 mg/mL, the disparity between countries can still be as much as twofold. Detection system, population genetics and dietary iron status were probably the first influencing factors. In terms of clinical application value, the AUC of D-dimer in predicting DVT (Deep Venous Thrombosis) was 0.86~0.90 in China. It is better than about 0.75 in foreign countries. The warning thresholds for postpartum hemorrhage, preeclampsia and fetal growth restriction also vary from region to region. We call for the establishment of localized reference intervals according to gestational age, delivery method and risk level as soon as possible before there is a unified standard, and dynamic monitoring in the same testing place should be used to reduce false positive results, avoid excessive anticoagulation, and implement accurate prevention and control of thrombotic diseases in pregnancy.