内蒙古医学杂志

目的 探讨妊娠期D-二聚体联合子宫动脉多普勒超声参数对胎盘早剥的预测价值。方法 选取我院2023年12月至2025年3月收治的124例胎盘早剥孕妇作为研究组，另选择同期正常分娩的孕妇100例作为对照组。所有孕妇均行子宫动脉多普勒超声检查，记录子宫动脉超声参数[搏动指数(PI)、阻力指数(RI)、收缩期峰值流速/舒张末期流速比值(S/D)],应用免疫比浊法测定血清D-二聚体水平。多因素Logistic回归分析胎盘早剥的影响因素，并制作受试者工作特征(ROC)曲线评估血清D-二聚体及PI、RI、S/D参数对孕妇胎盘早剥的预测价值。结果 两组年龄、孕周等基本资料比较差异无统计学意义(均P>0.05);两组妊娠期糖尿病、妊娠期高血压、胎膜早破、羊水过多情况比较，差异具有统计学意义(均P<0.05)。研究组血清D-二聚体水平(3.91±0.82)mg/L、PI(1.24±0.18)、RI(0.73±0.15)、S/D(3.09±0.61)参数值均高于对照组(1.07±0.35)mg/L、(0.89±0.13)、(0.56±0.11)、(2.20±0.42)(t=32.330,16.311,9.464,12.408;均P<0.05)。Logistic回归分析显示，合并妊娠期糖尿病、合并妊娠期高血压疾病、胎膜早破、羊水过多、D-二聚体升高、PI升高、RI升高、S/D升高均是胎盘早剥的独立危险因素(Waldχ²=5.196,13.681,10.022,10.235,12.621,12.617,12.544,6.910;均P<0.05)。ROC曲线分析显示，血清D-二聚体、PI、RI、S/D参数单独预测胎盘早剥的AUC分别为0.956、0.941、0.849、0.890,四者联合预测胎盘早剥的AUC为0.988。结论 妊娠期监测D-二聚体水平及子宫动脉PI、RI、S/D值对预测胎盘早剥具有重要价值，四者联合可显著提高预测效能，为早期识别高风险孕妇提供可靠依据。

Objective To investigate the predictive value of D-dimer combined with uterine artery Doppler ultrasound parameters for placental abruption during pregnancy. Methods A total of 124 pregnants women with placental abruption admitted to our hospital from December 2023 to March 2025 were selected as the study group, and 100 healthy pregnant women with normal deliveries during the same period were selected as the control group. All participants underwent uterine artery Doppler ultrasound examinations, and the following parameters were recorded: pulsatility index(PI), resistance index(RI), and systolic-to-diastolic ratio(S/D). Serum D-dimer levels were measured using immunoturbidimetry. Multivariate logistic regression analysis was performed to identify influencing factors of placental abruption, and receiver operating characteristic(ROC) curves were constructed to evaluate the predictive value of serum D-dimer, PI, RI, and S/D for placental abruption. Results There were no statistically significant differences in age, gestational age, or other baseline characteristics between the two groups(all P>0.05). However, significant differences were observed in gestational diabetes mellitus, gestational hypertension, premature rupture of membranes, and polyhydramnios(all P<0.05). The study group exhibited higher serum D-dimer levels(3.91±0.82) mg/L, PI(1.24±0.18), RI(0.73±0.15), and S/D(3.09±0.61) compared to the control group(1.07±0.35) mg/L,(0.89±0.13),(0.56±0.11), and(2.20±0.42), respectively)(t= 32.330, 16.311, 9.464, 12.408; all P<0.05). Logistic regression analysis revealed that gestational diabetes mellitus, gestational hypertension, premature rupture of membranes, polyhydramnios, elevated D-dimer, increased PI, elevated RI, and higher S/D were all independent risk factors for placental abruption(Wald χ²= 5.196, 13.681, 10.022, 10.235, 12.621, 12.617, 12.544, 6.910; all P<0.05). ROC curve analysis demonstrated that the AUC values for predicting placental abruption using serum D-dimer, PI, RI, and S/D alone were 0.956, 0.941, 0.849, and 0.890, respectively, while the combined prediction of all four parameters yielded an AUC of 0.988. Conclusion Monitoring D-dimer levels and uterine artery PI, RI, and S/D values during pregnancy is highly valuable for predicting placental abruption. The combination of these four parameters significantly improves predictive accuracy, providing a reliable basis for early identification of high-risk pregnant women.