低分子肝素治疗不明原因早期复发性流产的临床疗效研究

Clinical efficacy of molecular weight heparin in the treatment of unexplained early recurrent spontaneous abortion

目的探讨低分子肝素(LMWH)对不明原因早期复发性流产(RSA)的临床治疗效果及安全性。方法选择100例不明原因复发性流产患者,随机分为治疗组和对照组,每组50例,两组均从妊娠早期开始,一般在血β-HCG诊断妊娠或者超声确定宫内妊娠后开始用药。对照组:黄体酮20 mg,肌内注射,1次/d;绒毛膜促性腺激素1 000 U,肌内注射,1次/d,直至妊娠12周。治疗组:在对照组治疗基础上,给予低分子肝素5 000 U脐周皮下注射,1次/d。观察两组的妊娠结局、药物副作用及新生儿畸形发生情况。结果治疗组的活胎率为90%,对照组为62%,两组差异有统计学意义(P<0.05)。对照组的药物副作用发生率为74%,高于治疗组的24%,差异有统计学意义(P<0.05)。两组均无新生儿畸形发生。结论低分子肝素能够明显改善不明原因早期复发性流产患者的妊娠结局且对新生儿无不良影响。

Objective To investigate the clinical effect and safety of low molecular weight heparin （ LMWH） for unexplained early recurrent spontaneous abortion （ RSA） .Methods One hundred patients with unexplained RSA were randomly divided into treatment group and control group , with 50 cases in each group .Both groups began to re-ceive drugs treatment from early pregnancy , usually after pregrancy was diagnosed by the blood β-HCG or intrauterine pregnancy was dinenosed by ultrasound examination .The control group received the following therapy： progesterone 20 mg, intramuscular injection , once a day;chorionic gonadotropin 1 000 U, intramuscular injection , once a day un-til 12 weeks of pregnancy .The treatment group was given low molecular weight heparin 5 000 U pariumbilical subcu-taneous injection once a day based on the above treatment .After treatment, the pregnancy outcomes , drug side effects and neonatal malformations were observed in the two groups .Results The live births rate in the treatment group was 90%, that in the control group was 62%, the difference in the live births rate between the two groups was statistically significant （ P 〈0.05 ）; the incidence of adverse drug reactions in the control group was 74%, higher than that （ 24%） in the treatment group , the difference was statistically significant （ P〈0.05 ）;there were no neonatal malfor-mations in the two groups .Conclusion LMWH can significantly improve the pregnancy outcome of patients with un-explained early recurrent spontaneous abortion and has no adverse effects on the newborns .