复发性流产,低分子肝素,阿司匹林,血栓前状态,免疫功能,妊娠结局,肝功能," /> 复发性流产,低分子肝素,阿司匹林,血栓前状态,免疫功能,妊娠结局,肝功能,"/> Recurrent abortion, Low molecular weight heparin,Aspirin,Prethrombotic state, Immune function,Pregnancy outcome,Liver function
,"/> <span style="font-size:14px;line-height:2;">低分子肝素联合小剂量阿司匹林对复发</span><span style="font-size:14px;line-height:2;">性流产患者血栓前状态、肝功能及免疫</span><span style="font-size:14px;line-height:2;">功能的影响</span>
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发育医学电子杂志  2021, Vol. 9 Issue (3): 214-219    DOI: 10.3969/j.issn.2095-5340.2021.03.009
  围产医学   论著 |产科 |
低分子肝素联合小剂量阿司匹林对复发性流产患者血栓前状态、肝功能及免疫功能的影响
卢雪景 梁建梅 申林林 白娅琴 秦丽欣 高金霞 王亚凡
石家庄市妇幼保健院 妇产科,河北 石家庄 050000
Effects of low molecular weight heparin combined with low dose aspirin on prethrombotic state, liver function and immune function in patients with recurrent abortion
Lu Xuejing, Liang Jianmei, Shen Linlin, et al
Department of Gynecology and Obstetrics, Shijiazhuang Maternal and Child Health Hospital, HeBei, Shijiazhuang 050000,China
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摘要 【摘要】 目的  探讨低分子肝素联合小剂量阿司匹林对复发性流产患者血栓前状态、肝功能及免疫功
能的影响。 方法 2018 年1 月至2019 年6 月,在石家庄市妇幼保健院收治的复发性流产患者中,选
取108 例为研究对象,以随机数字表法分为观察组(54 例)、对照组(54 例)。两组均在确认宫内妊娠后
予以黄体酮注射液、黄体酮胶囊、叶酸片、维生素E 片等进行常规干预。在此基础上对照组予以小剂量
阿司匹林片治疗,服用至妊娠20 周;观察组在对照组基础上予以低分子肝素钙注射液治疗,应用至妊
娠12 周。两组均随访至妊娠。观察两组治疗前、妊娠20 周的血栓前状态相关指标、肝功能、免疫功能,
比较两组妊娠结局及妊娠期并发症。采用t 检验和χ2 检验进行统计学分析。 结果  妊娠20 周,观察
组与对照组的血浆抗凝血酶Ⅲ(antithrombin Ⅲ,AT- Ⅲ)活性[(107±9)% 与(98±8)%]、蛋白S 活性[(98±13)% 与(91±11)%]及血清转化生长因子-1(transforming growth factor -1,TGF-1)水平[(671±98)与(602±87)μg/L]均高于治疗前,且观察组高于对照组(P<0.05)。妊娠20 周,观察组与对照组的血清纤溶酶原激活抑制剂-1(plasminogen activator inhibitor-1,PAI-1)水平[(20±4)与(26±5)μg/L]、组织型纤溶酶原激活物(tissue plasminogen activator,t-PA)水平[(10.5±0.9)与(11.1±1.1)μg/L]、丙氨酸氨基转移酶(alanine aminotransferase,ALT)水平[(17±6)与(21±7)U/L]、白蛋白(albumin,ALB)水平[(29.1±1.6)与(32.9±2.2)g/L]、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)水平[(16.2±2.0)与(18.5±4.7)U/L]、白细胞介素(interleukin,IL)-17 水平[(240±44)与(281±53)ng/L]、γ- 干扰素(interferon-γ,IFN-γ)水平[(150±13)与(161±21)ng/L]、IL-6 水平[(42±14)与(53±19)μg/L]均低于
治疗前,且观察组低于对照组(P<0.05)。观察组与对照组的保胎成功率分别为90.7%(49/54)与70.4%
(38/54),足月产率分别为75.9%(41/54)与57.4%(31/54),观察组高于对照组(P<0.05)。观察组与对照组的胎儿存活率分别为13.0%(7/54)与14.8%(8/54),妊娠期并发症发生率分别为7.4%(4/54)与14.8%(8/54),两组比较差异无统计学意义(P>0.05)。 结论 低分子肝素联合小剂量阿司匹林可有效改善复发性流产患者的血栓前状态、免疫功能及妊娠结局,且不会对肝功能产生严重损伤。
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关键词:  复发性流产')" href="#">复发性流产  低分子肝素  阿司匹林  血栓前状态  免疫功能  妊娠结局  肝功能    
Abstract: 【Abstract】 Objective To explore the effects of low molecular weight heparin combined with low
dose aspirin on prethrombotic state, liver function and immune function of patients with recurrent abortion.Methods From January 2018 to June 2019, 108 patients with recurrent abortion in Shijiazhuang Maternaland Child Health Hospital were selected as research objects, and they were divided into the observation group(54 cases) and the control group (54 cases) according to the random number table method. After confirmingthe intrauterine pregnancy, both groups received routine intervention with progesterone injection, progesteronecapsule, folic acid tablets, vitamin E tablets, etc. Both groups were treated with low-dose aspirin tabletsuntil 20 weeks of pregnancy, meanwhile the patients of observation group were treated with low molecular weight heparin calcium injection until 12 weeks of pregnancy. Both groups were followed up to pregnancy.The indexes of prethrombotic state, liver function and immune function were observed before treatment andat 20 weeks of pregnancy, and the pregnancy outcomes and complications were compared between the twogroups. Chi-square test and t test were used for statistical analysis. Results At the 20th week of pregnancy, the plasma antithrombin Ⅲ (AT- Ⅲ ) activity [(107±9)% vs (98±8)%], protein S (PS) activity [(98±13)%vs (91±11)%] and serum transforming growth factor -1 (TGF-1) [(671±98) vs (602±87) μg/L] in observationgroup and control group were higher than those before treatment, and those in observation group were higher than control group (P<0.05). At the 20th week of pregnancy, the level of serum plasminogen activator inhibitor-1
(PAI-1) [(20±4) vs (26±5) μg/L], tissue plasminogen activator (t-PA) [(10.5±0.9) vs (11.1±1.1) μg/L], alanineaminotransferase (ALT) [(17±6) vs (21±7) U/L], albumin (ALB) [(29.1±1.6) vs (32.9±2.2) g/L],
aspartate aminotransferase (AST) [(16.2±2.0) and (18.5±4.7) U/L], interleukin (IL)-17 [(240±44)
vs (281±53) ng/L], interferon-γ [(150±13) vs (161±21) ng/L], IL-6 [(42±14) vs (53±19) μg/L] were
lower than those before treatment, and those in observation group were lower than control group (P<0.05).The success rate of miscarriage prevention in observation group was higher than that in control group [90.7%(49/54) vs 70.4% (38/54)], and so was the rate of full-term birth [75.9% (41/54) vs 57.4% (31/54)] (P<0.05).The fetal survival rate of the observation group and the control group was 13.0% (7/54) vs 14.8% (8/54),and the incidence of complications during pregnancy was 7.4% (4/54) and 14.8% (8/54), respectively, withno significant difference between the two groups (P>0.05). Conclusion Low molecular weight heparincombined with low dose aspirin can effectively improve prethrombotic state, immune function and pregnancyoutcome of patients with recurrent abortion, and will not cause serious damage to liver function.
Key words:  Recurrent abortion')" href="#">Recurrent abortion    Low molecular weight heparin    Aspirin    Prethrombotic state    function')" href="#"> Immune function    Pregnancy outcome    Liver function
收稿日期:  2020-01-21                     发布日期:  2021-05-27     
基金资助: 河北省重点科技研究计划(20191418)
通讯作者:  卢雪景    E-mail:  435136278@qq.com
引用本文:    
卢雪景 梁建梅 申林林 白娅琴 秦丽欣 高金霞 王亚凡. 低分子肝素联合小剂量阿司匹林对复发性流产患者血栓前状态、肝功能及免疫功能的影响[J]. 发育医学电子杂志, 2021, 9(3): 214-219.
Lu Xuejing, Liang Jianmei, Shen Linlin, et al. Effects of low molecular weight heparin combined with low dose aspirin on prethrombotic state, liver function and immune function in patients with recurrent abortion. Journal of Developmental Medicine(Electronic Version), 2021, 9(3): 214-219.
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[2] 刘盾 关怀. 复发性流产的病因及治疗进展[J]. 发育医学电子杂志, 2018, 6(4): 208-212.
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