低分子肝素治疗ART妊娠后复发性流产的效果及对激素水平、凝血功能的影响
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摘要
目的:分析低分子肝素治疗人类辅助生殖技术(ART)获得妊娠后复发性流产效果及对激素、凝血功能的影响。方法:选取本院2013年1月—2017年12月收治的接受ART后有先兆流产的早孕复发性流产患者120例,根据治疗方法不同分为对照组和观察组。对照组采用常规治疗,观察组采用常规治疗+低分子肝素治疗,观察两组治疗临床效果。结果:治疗前,两组绒毛膜促性腺激素(HCG)、孕酮(P)、雌二醇(E_2)、D-二聚体(D-D)、纤溶酶原激活物抑制物1(PAI-1)、纤维蛋白原水平比较无差异(P>0.05)。治疗后,观察组HCG、P、E_2水平高于对照组,D-D、PAI-1、纤维蛋白原水平低于对照组(P<0.05)。观察组足月生产率高于对照组、流产率低于对照组(P<0.05),早产率与对照组比较无差异(P>0.05)。两组血小板减少、牙龈出血、瘀斑、胃肠道反应等发生率比较无差异(P>0.05)。结论:低分子肝素治疗ART获得妊娠后复发性流产,可改善患者激素水平和高凝状态,提高足月生产率,降低流产率,且安全性较好。
Objective: to analyze the effect of low molecular weight heparin(LMWH) for treating pregnant women with recurrent abortion after human assisted reproductive technique(ART) ART and its influence on hormone levels and pregnancy outcomes of women. Methods: From January 2013 to December 2017, 120 early pregnant women with recurrent abortion who received ART were selected and divided into control group and observation group according to different treatment methods. The women in control group were treated by routine therapy, and the women in observation group were treated by low molecular weight heparin except to routine therapy. The therapy efficacy of women in both groups was analyzed. Results: Before treatment, there were no significant different in the levels of human chorionic gonadotropin(HCG), progesterone(P), estradiol(E_2), D-dimer(D-D), fibrin enzyme activators inhibitor 1(PAI-1), and fibrinogen of women between the two groups(P>0.05). After treatment, the levels of HCG, P, and E_2 of women in observation group were significant higher than those of women in control group(P<0.05), but the levels of D-D, PAI-1, and fibrinogen were significant lower than those of women in control group(P<0.05). The rate of full-term pregnancy of women in observation group was significant higher than those of women in control group(P<0.05), but abortion rate was significant lower than that of women in control group(P<0.05). The rate of premature delivery, and incidences of thrombocytopenia, gingival hemorrhage, and ecchymosis and gastrointestinal reaction had no significant different between the two groups(P>0.05). Conclusion: LMWH used for treating pregnant women with recurrent abortion after ART can improve the rate of full-term pregnancy and reduce abortion rate, and has high safety.
Objective: to analyze the effect of low molecular weight heparin(LMWH) for treating pregnant women with recurrent abortion after human assisted reproductive technique(ART) ART and its influence on hormone levels and pregnancy outcomes of women. Methods: From January 2013 to December 2017, 120 early pregnant women with recurrent abortion who received ART were selected and divided into control group and observation group according to different treatment methods. The women in control group were treated by routine therapy, and the women in observation group were treated by low molecular weight heparin except to routine therapy. The therapy efficacy of women in both groups was analyzed. Results: Before treatment, there were no significant different in the levels of human chorionic gonadotropin(HCG), progesterone(P), estradiol(E_2), D-dimer(D-D), fibrin enzyme activators inhibitor 1(PAI-1), and fibrinogen of women between the two groups(P>0.05). After treatment, the levels of HCG, P, and E_2 of women in observation group were significant higher than those of women in control group(P<0.05), but the levels of D-D, PAI-1, and fibrinogen were significant lower than those of women in control group(P<0.05). The rate of full-term pregnancy of women in observation group was significant higher than those of women in control group(P<0.05), but abortion rate was significant lower than that of women in control group(P<0.05). The rate of premature delivery, and incidences of thrombocytopenia, gingival hemorrhage, and ecchymosis and gastrointestinal reaction had no significant different between the two groups(P>0.05). Conclusion: LMWH used for treating pregnant women with recurrent abortion after ART can improve the rate of full-term pregnancy and reduce abortion rate, and has high safety.
引文
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[2] 郭义红,李晓彬,陈亮,等.小剂量低分子肝素联合免疫球蛋白治疗难治性先兆流产合并绒毛膜下血肿效果评价[J].临床和实验医学杂志,2017,16(16):1623-1627.
[3] 高媛,乔宠.低分子肝素治疗复发性流产对肝功能的影响[J].中国医科大学学报,2016,45(6):535-537.
[4] 黄菁.低分子肝素与小剂量阿司匹林治疗免疫性反复流产的有效性与安全性[J].现代实用医学,2016,28(3):364-365.
[5] 余瑾.实用中西医结合妇产科学[M].北京:北京医科大学、中国协和医科大学联合出版社,1997:335.
[6] 刘育,赵烨.低分子肝素对复发性流产伴抗磷脂抗体阳性孕妇治疗的Meta分析[J].中国药物与临床,2016,16(6):874-876.
[7] 韩宁,许雅娟.固肾安胎丸联合低分子肝素干预复发性流产妇女血栓前状态的疗效[J].中成药,2017,39(12):2481-2484.
[8] 靳萍萍.阿司匹林和低分子肝素治疗习惯性流产的临床效果[J].临床医学,2016,36(1):15-16.
[9] 袁燕,郑九生.低分子肝素在产科应用中的研究进展[J].现代妇产科进展,2016,25(8):631-632.
[10] Tsikouras P, Christoforidou A, Bothou A, et al. Overcoming heparin resistance in pregnant women with antithrombin deficiency: a case report and review of the literature[J]. Journal of Medical Case Reports, 2018, 12(1):169.
[11] 王金英.低分子肝素联合地屈孕酮对复发性流产患者妊娠结局的影响[J].中国药物经济学,2017,12(7):50-52.
[12] 唐艳,何菊,马婷等.低分子肝素联合阿司匹林对复发性自然流产患者血凝状态的影响[J].湖南师范大学学报(医学版),2017,14(2):165-167.
[13] 王华.低分子肝素对血栓前状态致复发性流产患者D-D、TT、AT-Ⅲ含量及妊娠结局的影响[J].北方药学,2017,14(7):81.
[14] Khalife D, Ghazeeri G. Recurrent Implantation Failure and Low Molecular Weight Heparin[J]. Open Journal of Obstetrics & Gynecology, 2018, 8(2):146-162.
[15] 付雪梅,王丹,郝鹏锴等.阿司匹林联合低分子肝素治疗血栓前状态致复发性流产84例临床分析[J].中国妇幼保健,2016,31(8):1681-1683.