Page 110 - 南京医科大学自然版

南京医科大学学报（自然科学版） 第45卷第12期
·1792 · Journal of Nanjing Medical University（Natural Sciences） 2025年12月

·临床研究·

D⁃二聚体新阈值对剖宫产术后肺栓塞的预测意义

周 雪 ，王新艳，乌 兰
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南京医科大学附属妇产医院（南京市妇幼保健院）产科，江苏 南京 210004

［摘 要］ 目的：探究剖宫产术后D⁃二聚体的新阈值，以作为剖宫产术后肺栓塞（pulmonary embolism，PE）的预测因子。方法：
选取2018年1月1日—2024年12月31日在南京医科大学附属妇产医院分娩的疑似PE的剖宫产术后患者共198例，进行回顾
性病例对照研究，其中 33 例经 CT 肺动脉造影（computed tomographic pulmonary angiography，CTPA）最终诊断为 PE 为研究组，
165例经CTPA排除PE为对照组。分析两组患者的年龄、体重指数（body mass index，BMI）、分娩孕周、胎儿数量、手术指征、产
后静脉血栓栓塞症的危险因素、术后24 h以内D⁃二聚体浓度值及抗凝启动时间等。绘制D⁃二聚体的受试者工作特征（receiver
operating characteristic，ROC）曲线以确定D⁃二聚体值的最佳敏感度和特异度，曲线下面积（area under the curve，AUC）用于评价
临界值。分析 PE 的危险因素，计算比值比（OR）与 95%置信区间。结果：PE 组 D⁃二聚体水平显著高于非 PE 组［6.82（4.46，
13.06）mg/L vs. 3.83（2.35，5.21）mg/L，P < 0.01］，PE组术后启动抗凝的时间晚于非PE组［1（0，3）d vs. 2（1，5）d，P < 0.05］。剖宫
产术后24 h内D⁃二聚体水平的最佳截断值为7.48 mg/L，特异度为93.9%，敏感度为62.4%，AUC为0.75（95% CI：0.652~0.848，
P < 0.001）；而当D⁃二聚体截断值调整为1.59 mg/L 时，其敏感度和特异度分别为100%和43.2%，在阴性预测值中约登指数最
高，该值的确定对剖宫产术后PE的早期排查可能有重要意义。长时间制动和D⁃二聚体水平是PE的2个独立危险因素，其中D⁃二
聚体水平是PE的连续风险因素（OR=1.58）。结论：剖宫产术后24 h内D⁃二聚体是PE连续、独立的风险因素且是强预测指标，
可以作为识别剖宫产术后PE更为便捷、安全的筛查方法，以便及时干预并减少不必要的成像检查。
［关键词］ D⁃二聚体；剖宫产术；肺栓塞；新阈值
［中图分类号］ R714.253 ［文献标志码］ A ［文章编号］ 1007⁃4368（2025）12⁃1792⁃07
doi：10.7655/NYDXBNSN250795

Predictive significance of the new cutoff values of D⁃dimer for pulmonary embolism after
cesarean section

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ZHOU Xue ，WANG Xinyan，WU Lan
Department of Obstetrics，Women’s Hospital of Nanjing Medical University（Nanjing Women and Children’s
Healthcare Hospital），Nanjing 210004，China

［Abstract］ Objective：To explore the new D⁃dimer cutoff values after cesarean section as a predictive factor for pulmonary embolism
（PE）. Methods：A total of 198 women with suspected PE after cesarean section who delivered at the Women’s Hospital Affiliated to
Nanjing Medical University from January 1，2018，to December 31，2024，were selected for a retrospective case ⁃ control study. 33
patients were finally diagnosed with PE by computed tomographic pulmonary angiography（CTPA）and were included in the study
group，while 165 patients were excluded from having PE by CTPA and were included in the control group. Analyze the age，body mass
index（BMI），gestational age at delivery（weeks），number of fetuses，surgical indications，risk factors for venous thromboembolism
（VTE）after delivery，D⁃dimer concenrtration within postpartum 24 h，and the time of using LMWH after cesarean section. The receiver
operating characteristic（ROC）curve of D⁃dimer was plotted to determine the optimal sensitivity and specificity of the D⁃dimer value，
and the area under the curve（AUC）was used to evaluate the cutoff value. The risk factors for PE were analyzed，and the odds ratio（OR）
and 95% confidence interval were calculated. Results：The D⁃dimer level in the PE group was 6.82（4.46，13.06）mg/L，significantly
higher than that in the non⁃PE group 3.83（2.35，5.21）mg/L（P < 0.01），and the anticoagulation initiation time after surgery in the PE
group was later than that in the non⁃PE group［1（0，3）d vs. 2（1，5）d，P < 0.05］. The optimal cut⁃off value of D⁃dimer within 24 h

［基金项目］ 国家自然科学基金（81501252）
通信作者（Corresponding author），E⁃mail：maggiezhouxue840@163.com（ORCID：0009⁃0007⁃8916⁃8254）
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