小剂量阿司匹林肠溶片对改善妊高症高危患者127例凝血功能临床价值研究
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摘要
目的:探讨小剂量阿司匹林肠溶片对改善妊高症高危(PIH)患者凝血功能的临床价值。方法:采用随机数字法将127例PIH患者随机分为观察组(n=64)和对照组(n=63)。对照组给予安慰剂治疗,观察组给予阿司匹林肠溶片治疗。观察比较两组治疗前后凝血指标PT、APTT、TT、FIB、D-D变化,记录两组妊高症及不良反应发生情况。结果:观察组妊高症发病12例,发病率为18.75%,明显低于对照组的25例(39.68%),两组比较差异有统计学意义(X~2=6.738,P<0.05)。治疗前,观察组和对照组患者凝血功能指标PT、APTT、TT、FIB、D-D水平比较差异无统计学意义(P>0.05)。治疗后,对照组上述凝血功能指标水平未出现明显变化(P>0.05);观察组PT、APTT、TT明显延长,FIB、D-D含量明显下降,治疗前后比较差异具有统计学意义(P<0.01);且与对照组比,观察组治疗后PT、APTT、TT明显延长,FIB、D-D含量明显升高,组间比较差异有统计学意义(P<0.05)。观察组患者发生消化不良、胃痛及牙龈出血等不良反应7例,不良反应发生率10.94%,对照组发生此类不良反应5例,不良反应发生率7.94%,两组患者在治疗过程中的不良反应比较无统计学差异(X~2=0.334,P>0.05)。结论:小剂量阿司匹林肠溶片预防PIH临床疗效显著,可有效降低妊高症的发生概率,改善高危患者凝血功能状态,且具有较高安全性。
Objective: This study aims to investigate the clinical value of low-dose aspirin enteric-coated tablets in improving the coagulation function in patients with pregnancy induced hypertension(PIH). Methods: 127 patients with PIH were randomly assigned to observation group(n=64) and control group(n=63).The control group was given placebo treatment, while the observation group was treated with low-dose Aspirin Enteric-coated tablets. The changes of coagulation parameters PT, APTT, TT, FIB and D-D before and after treatment were observed and compared. The incidence of pregnancy-induced hypertension and adverse reactions was recorded. Results: The incidence of PIH in the observation group of 12 cases(18.75%) was statistically significantly lower than that of 25 cases(39.68%) in the control group(X~2=6.738, P<0.05). Before treatment, there was no significant difference in the levels of clotting function indicators PT, APTT, TT, FIB and D-D between the observation group and the control group(P>0.05). After treatment, there was no significant change in the level of coagulation function in the control group(P>0.05). The PT, APTT and TT in the observation group were significantly prolonged, and the contents of FIB and D-D were significantly decreased,and the difference between the two groups was statistically significant(P<0.01). Compared with the control group, PT, APTT and TT were significantly prolonged in the observation group, and the levels of FIB and DD were significantly increased,and the difference between the groups was statistically significant(P<0.05). There were 7 cases(10.94%) of adverse reactions such as dyspepsia, stomachache and gingival bleeding in the observation group, however 5 cases(10.94%) in the control group, which there was no significant difference between the two groups(X~2=0.334, P>0.05). Conclusion: Low-dose aspirin enteric-coated tablets have significant clinical efficacy in preventing PIH, which can effectively reduce the incidence of pregnancy-induced hypertension, improve the coagulation function of high-risk patients, and has high safety.
Objective: This study aims to investigate the clinical value of low-dose aspirin enteric-coated tablets in improving the coagulation function in patients with pregnancy induced hypertension(PIH). Methods: 127 patients with PIH were randomly assigned to observation group(n=64) and control group(n=63).The control group was given placebo treatment, while the observation group was treated with low-dose Aspirin Enteric-coated tablets. The changes of coagulation parameters PT, APTT, TT, FIB and D-D before and after treatment were observed and compared. The incidence of pregnancy-induced hypertension and adverse reactions was recorded. Results: The incidence of PIH in the observation group of 12 cases(18.75%) was statistically significantly lower than that of 25 cases(39.68%) in the control group(X~2=6.738, P<0.05). Before treatment, there was no significant difference in the levels of clotting function indicators PT, APTT, TT, FIB and D-D between the observation group and the control group(P>0.05). After treatment, there was no significant change in the level of coagulation function in the control group(P>0.05). The PT, APTT and TT in the observation group were significantly prolonged, and the contents of FIB and D-D were significantly decreased,and the difference between the two groups was statistically significant(P<0.01). Compared with the control group, PT, APTT and TT were significantly prolonged in the observation group, and the levels of FIB and DD were significantly increased,and the difference between the groups was statistically significant(P<0.05). There were 7 cases(10.94%) of adverse reactions such as dyspepsia, stomachache and gingival bleeding in the observation group, however 5 cases(10.94%) in the control group, which there was no significant difference between the two groups(X~2=0.334, P>0.05). Conclusion: Low-dose aspirin enteric-coated tablets have significant clinical efficacy in preventing PIH, which can effectively reduce the incidence of pregnancy-induced hypertension, improve the coagulation function of high-risk patients, and has high safety.
引文
[1] 张蕊. 妊高征患者TM、β-HCG、sVCAM-1水平检测及临床意义[J]. 中国实验诊断学, 2014,18(11):1860-1862.
[2] 王则绯,姜锋,暴蕾. 妊娠期高血压疾病患者胎盘组织中LXRα和Endoglin基因的表达[J]. 陕西医学杂志,2017,46(12):1741-1742.
[3] 郭敬敬, 陈萱. MMP-9与TIMP-2在妊娠期高血压疾病中的研究[J]. 中国优生与遗传杂志, 2012,20(11):4-6.
[4] 柳相珍, 张媛, 徐成伟, 等. 子痫前期患者血浆中可溶性内皮细胞蛋白C受体与血管性血友病因子及可溶性血栓调节蛋白的水平变化[J]. 中华检验医学杂志, 2016,39(10):783-785.
[5] 钱小泉, 宋艳萍, 王丽琴, 等. 血管内皮生长因子和缺氧诱导因子-1α在妊娠高血压综合征患者胎盘组织中的表达[J]. 生殖与避孕, 2014,34(8):628-632.
[6] 滕现勇, 詹红. 血浆纤维蛋白原测定及D-二聚体检测在妊娠高血压综合征中的意义[J]. 中华现代内科学杂志, 2006,3(11):1284-1285.
[7] 陈妙华. 妊娠高血压综合征的诊断及治疗分析[J]. 实用心脑肺血管病杂志, 2012,20(5):840-841.
[8] 李欣,李楠. 同型半胱氨酸、胱抑素C、D-二聚体及超敏C反应蛋白与妊娠期高血压疾病的相关性探讨[J]. 陕西医学杂志,2016,45(2):185-187.
[9] 雷春莲, 段钊. PIH患者血清D-二聚体及内皮素与脂肪因子水平及相关性研究[J]. 昆明医科大学学报, 2014,35(6):97-100.
[10] 王璐璐, 王雁. 阿司匹林抵抗与其分子生物学机制[J]. 中华老年心脑血管病杂志, 2016,18(4):431-433.
[11] 热孜万古丽·图尔汗,迪丽努尔·吐尔洪.疏血通配合阿斯匹林治疗急性缺血性脑卒中70例[J].陕西中医,2013,34(11):1467-1468.
[12] 乐杰. 妇产科学[M]. 7版. 北京: 人民卫生出版社, 2008:150-154.
[13] 赫英东, 陈倩. 补体系统检测在妊娠期高血压性疾病诊治中的临床价值[J]. 中华检验医学杂志, 2017,40(9):667-671.
[14] 吴扬. 妊娠期高血压疾病患者的预后特点及其影响因素[J]. 现代妇产科进展, 2013,22(8):666-668.
[15] 王金凤. 妊娠期糖尿病危险因素及对妊娠结局的影响[J]. 中国医药导报, 2017,14(24):135-138.
[16] 余秀琼. 妊高征的血管活性物质改变与发病机制的关系[J]. 国际妇产科学杂志, 1997,24(6):329-331.
[17] 唐超君, 徐世元, 谢秀萍. 凝血与纤溶系统水平对围术期产妇弥漫性血管内凝血的诊断价值[J]. 中国实验诊断学, 2014,18(7):1133-1136.
[18] 梁春玲, 王沂峰. 妇科手术对患者凝血和纤溶系统的短期影响[J]. 广东医学, 2015,36(10):1576-1579.
[19] 卡米拉合亚斯丁, 郝立君, 杨丽玮. 凝血及纤溶功能联合检测在妊娠高血压综合征患者中的临床价值[J]. 重庆医学, 2016,45(1):17-18.
[20] Carbillon L, Uzan S. Early treatment with low-dose aspirin is effective for the prevention of preeclampsia and related complications in high-risk patients selected by the analysis of their historic risk factors [J]. Blood, 2005,105(2): 902-903.
[21] Stavrakis S, Stoner JA, Azar M, et al. Low-dose aspirin for primary prevention of cardiovascular events in patients with diabetes: a meta-analysis [J]. Am J Med Sci, 2011, 341(1): 1-9.
[22] 史玉霞, 杨一新, 许倩, 等. 妊娠期高血压疾病患者血小板参数和凝血功能指标的变化及意义[J]. 海南医学院学报, 2015,21(10):1384-1386.
[23] 李欣, 李楠. 同型半胱氨酸、胱抑素C、D-二聚体及超敏C反应蛋白与妊娠期高血压疾病的相关性探讨[J]. 陕西医学杂志, 2016,45(2):185-187.
[2] 王则绯,姜锋,暴蕾. 妊娠期高血压疾病患者胎盘组织中LXRα和Endoglin基因的表达[J]. 陕西医学杂志,2017,46(12):1741-1742.
[3] 郭敬敬, 陈萱. MMP-9与TIMP-2在妊娠期高血压疾病中的研究[J]. 中国优生与遗传杂志, 2012,20(11):4-6.
[4] 柳相珍, 张媛, 徐成伟, 等. 子痫前期患者血浆中可溶性内皮细胞蛋白C受体与血管性血友病因子及可溶性血栓调节蛋白的水平变化[J]. 中华检验医学杂志, 2016,39(10):783-785.
[5] 钱小泉, 宋艳萍, 王丽琴, 等. 血管内皮生长因子和缺氧诱导因子-1α在妊娠高血压综合征患者胎盘组织中的表达[J]. 生殖与避孕, 2014,34(8):628-632.
[6] 滕现勇, 詹红. 血浆纤维蛋白原测定及D-二聚体检测在妊娠高血压综合征中的意义[J]. 中华现代内科学杂志, 2006,3(11):1284-1285.
[7] 陈妙华. 妊娠高血压综合征的诊断及治疗分析[J]. 实用心脑肺血管病杂志, 2012,20(5):840-841.
[8] 李欣,李楠. 同型半胱氨酸、胱抑素C、D-二聚体及超敏C反应蛋白与妊娠期高血压疾病的相关性探讨[J]. 陕西医学杂志,2016,45(2):185-187.
[9] 雷春莲, 段钊. PIH患者血清D-二聚体及内皮素与脂肪因子水平及相关性研究[J]. 昆明医科大学学报, 2014,35(6):97-100.
[10] 王璐璐, 王雁. 阿司匹林抵抗与其分子生物学机制[J]. 中华老年心脑血管病杂志, 2016,18(4):431-433.
[11] 热孜万古丽·图尔汗,迪丽努尔·吐尔洪.疏血通配合阿斯匹林治疗急性缺血性脑卒中70例[J].陕西中医,2013,34(11):1467-1468.
[12] 乐杰. 妇产科学[M]. 7版. 北京: 人民卫生出版社, 2008:150-154.
[13] 赫英东, 陈倩. 补体系统检测在妊娠期高血压性疾病诊治中的临床价值[J]. 中华检验医学杂志, 2017,40(9):667-671.
[14] 吴扬. 妊娠期高血压疾病患者的预后特点及其影响因素[J]. 现代妇产科进展, 2013,22(8):666-668.
[15] 王金凤. 妊娠期糖尿病危险因素及对妊娠结局的影响[J]. 中国医药导报, 2017,14(24):135-138.
[16] 余秀琼. 妊高征的血管活性物质改变与发病机制的关系[J]. 国际妇产科学杂志, 1997,24(6):329-331.
[17] 唐超君, 徐世元, 谢秀萍. 凝血与纤溶系统水平对围术期产妇弥漫性血管内凝血的诊断价值[J]. 中国实验诊断学, 2014,18(7):1133-1136.
[18] 梁春玲, 王沂峰. 妇科手术对患者凝血和纤溶系统的短期影响[J]. 广东医学, 2015,36(10):1576-1579.
[19] 卡米拉合亚斯丁, 郝立君, 杨丽玮. 凝血及纤溶功能联合检测在妊娠高血压综合征患者中的临床价值[J]. 重庆医学, 2016,45(1):17-18.
[20] Carbillon L, Uzan S. Early treatment with low-dose aspirin is effective for the prevention of preeclampsia and related complications in high-risk patients selected by the analysis of their historic risk factors [J]. Blood, 2005,105(2): 902-903.
[21] Stavrakis S, Stoner JA, Azar M, et al. Low-dose aspirin for primary prevention of cardiovascular events in patients with diabetes: a meta-analysis [J]. Am J Med Sci, 2011, 341(1): 1-9.
[22] 史玉霞, 杨一新, 许倩, 等. 妊娠期高血压疾病患者血小板参数和凝血功能指标的变化及意义[J]. 海南医学院学报, 2015,21(10):1384-1386.
[23] 李欣, 李楠. 同型半胱氨酸、胱抑素C、D-二聚体及超敏C反应蛋白与妊娠期高血压疾病的相关性探讨[J]. 陕西医学杂志, 2016,45(2):185-187.