| Objective To investigate the serum levels of platelet aggregation(PAgT),plasma fibrinogen(FIB)and d-dimer in gestational diabetes mellitus(GDM)and normal pregnant women.The changes of the platelet aggregation,plasma fibrinogen(FIB)and d-dimer in the GDM group and the normal control group were measured.And its correlation with BMI,blood glucose and other indicators were measured.To explore the clinical value of prethrombotic state prediction of PAgT,FIB and d-dimer in patients with GDM.Methods Using the retrospective study method,selected patients of obstetric examination and childbirth from February 2016 to July 2017 in Kunshan first people’s hospital maternity clinic inspection and production,which 200 pregnant women with gestational diabetes mellitus as group GDM,and another 200 normal pregnant women the same period in our hospital were selected as the control group.Two groups of pregnant women were separately measured the platelet aggregation rate(PAgT),plasma fibrinogen(FIB),D–dimer,prothrombin time(PT),thrombin time(APTT)and thrombin time(TT)value.At the same time,record the years of age,sampling gestational age,blood pressure before pregnancy,body mass index(BMI)before pregnancy,weight of ante partum,body mass index(BMI)of ante partum,fetal birth weight and OGTT test results and glycosylated hemoglobin.Compare the pregnancy Complications and pregnancy outcome of the two groups of pregnant women.Compare the difference of platelet aggregation(PAgT)plasma fibrinogen(FIB)D-dimer between the GDM group and the normal pregnancy group,using Logistic regression analysis to multiple-factor analyze the relatition between the related factors of gestational diabetes and platelet aggregation rate(PAgT)plasma fibrinogen(FIB)D-dimer.Results1.Data analysis of gestational diabetes group and control group Included in the study of GDM group,age(28.73±4.34)years of age,sampling gestational age(38.67±1.43)week,number of pregnancy(1.76±0.88)times,blood pressure before pregnancy(113.66±10.72/69.61±8.94)mmHg,body mass index(BMI)before pregnancy(21.22±2.30)kg/m~2,weight of ante partum(69.51±10.71)kg,body mass index(BMI)of ante partum(27.28±2.25)kg/m~2,fetal birth weight(3406.7±402.89)g.Pregnant women who were enrolled in normal pregnancy,age(28.13±3.90)years of age,sampling gestational age(38.65±1.12)week,number of pregnancy(1.73±0.87)times,blood pressure before pregnancy(112.84±9.35/68.97±8.51)mmHg,body mass index(BMI)before pregnancy(20.84±2.17)kg/m~2,weight of ante partum(66.70±7.95)kg,body mass index(BMI)of ante partum(26.40±2.13)kg/m~2,fetal birth weight(3346.68±354.80)g.The results showed that there was no statistically significant difference between the two groups,such as age,sampling gestational age,number of pregnancy,blood pressure before pregnancy,body mass index(BMI)before pregnancy and fetal birth weight(P>0.05).There were statistically significant differences in the weight of ante partum and body mass index(BMI)of ante partum between the two groups(P<0.05).The glycosylated hemoglobin value of GDM group(5.12±0.34)%,OGTT test fasting blood glucose(5.05±0.65)mmol/L,1 hour blood glucose(9.59±1.68)mmol/L,2 hours of blood glucose(8.28±1.65)mmol/L.The glycosylated hemoglobin value of normal pregnant women(5.00±0.32)%,OGTT test fasting blood glucose(4.44±0.33)mmol/L,1 hour blood glucose(7.87±1.12)mmol/L,2 hours blood glucose(6.61±0.95)mmol/L.The glycosylated hemoglobin and OGTT blood glucose level in GDM group were significantly higher than that in the control group,and the difference was statistically significant(P<0.05).2.Complications of pregnancy and pregnancy outcome in GDM group and the control group The results of pregnancy complications and pregnancy outcomes in both groups showed that there was a statistically significant difference between the two groups of pregnant women with gestational hypertension,fetal distress,polyhydramnios,premature rupture of membranes(P<0.05).There was no statistically significant difference between the two groups of pregnant women with postpartum haemorrhage,giant baby,infant of low-birth weight(P>0.05).3.Comparison of traditional coagulation programs in GDM group and the control group PT(11.91±0.63)s,APTT(29.44±2.60)s of GDM group was obviously lower than the PT(12.04±0.59)s,APTT(30.26±3.12)s of the control group,the difference was statistically significant(t=2.146,t=2.836,P<0.05),whereas FIB(4.18±0.52)g/L of GDM group was obviously higher than that of control group(4.18±0.52)g/L,the difference was statistically significant(t=3.907,P<0.05).TT(16.04±1.04)s of GDM group was obviously higher than the TT(16.13±1.08)s of the control group,the difference was no statistically significant(t=0.833,P>0.05).4.The GDM group was compared with the prethrombotic state marker in the control group The PAgT(44.46±9.12)%,D-dimer value(2.44±1.47)mg/L of GDM pregnant women is significantly higher than the PAgT(39.97±7.55)%,D-dimer value(2.01±0.87)mg/L of normal pregnancy pregnant women,two groups of data exists difference(P<0.05),with statistical significance.5.Logistic regression analysis was used to analyze the correlation of gestational diabetes mellitus with multiple factors.In this study,two classifications of Logistic regression were used to analyze the related factors of gestational diabetes mellitus:the age,sampling gestational age,body mass index(BMI)of ante partum,glycosylated hemoglobin,PT,APTT,FIB,D-Dimer,PAgT,for single factor and multifactor analysis.The results of univariate analysis showed that the body mass index(BMI),glycosylated hemoglobin,PT,APTT,FIB,D-Dimer,PAgT,were associated with gestational diabetes.Multivariate analysis showed that the body mass index(BMI),glycosylated hemoglobin,FIB,D-Dimer,PAgT was an independent risk factor for gestational diabetes.The greater the BMI,the higher the risk of gestational diabetes,and there were high levels of FIB,D-Dimer,PAgT in gestational diabetes patients.The PAgT,FIB and D-Dimer concentration in GDM patients increased with the increase of GHb level,showing a significant positive correlation,while the APTT,PT change was not significantly correlated with GHb level.6.The ROC curve analysis of prethrombotic state related indicators which were used to determine the prethrombotic state of gestational diabetes.The ROC curve analysis of PT,APTT,FIB,D-dimer,PAgT was performed to determine the prethrombotic state of gestational diabetes.It was found that PAgT value was a good indicator for determining the prethrombotic state of gestational diabetes.Conclusion1.In the development of GDM,there is a balance disorder of coagulation and fibrinolysis system.2.Patients with GDM had a significantly higher pre-thrombotic state than those of normal pregnant women3.The study of platelet aggregation rate(PAgT),plasma fibrinogen(FIB)and D-dimer in GDM patients can effectively monitor the progression of prethrombotic state in GDM patients,and to guide clinical early intervention,alleviate or delay complications,To improve the mother and child outcomes are of great significance. |
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