钙剂加阿司匹林综合治疗妊娠期高血压疾病的疗效及机制

Efficacy of calcium and aspirin in treatment of pregnancy-induced hypertension and its mechanism

目的：探讨钙剂加小剂量肠溶阿司匹林对妊娠期高血压疾病的疗效及可能的机制.方法：妊娠期高血压疾病的孕妇78例分为对照组和实验组各39例,前者仅用硫酸镁常规解痉降压,后者在解痉降压基础上口服多维钙咀嚼片（迪巧）及小剂量肠溶阿司匹林.观察两组母婴结局.平均动脉血压、24h尿蛋白和血清钙水平的改变,以及凝血和血栓前状态分子标志物水平的变化.结果：实验组和对照组胎心异常率依次为7.69%和23.08%,差异具有统计学意义（P〈0.01）.治疗前实验组平均动脉血压为（126.2±15.6）mmHg（1mmHg=0.133kPa）,24h尿蛋白为（3.85±0.47）g和血清钙为（1.83±0.41）mmol/L,治疗后依次为（102.5±16.8）mmHg,（1.56±0.63）g和（2.44±0.35）mmol/L,差异具有统计学意义（P〈0.01～0.05）.实验组治疗前PT,Fbg,TAT和D-dimer检测值依次为（10.92±0.55）s,（5.8±1.3）g/L,（24.5±4.3）mg/L和（1.55±0.46）mg/L,治疗后依次为（11.26±0.82）s,（4.2±0.6）g/L,（9.56±3.7）mg/L和（0.72±0.22）mg/L,差异均具有统计学意义（P〈0.01～0.05）.结论：钙剂加小剂量肠溶阿司匹林治疗妊娠期高血压疾病效果较好,能有效降低平均动脉血压,改善患者孕妇凝血功能和血栓前状态,改善母婴结局.

AIM： To explore the roles of calcium combined with low-dose of enteric-coated aspirin in treatment of pregnancyinduced hypertension and its possible mechanisms. METHODS： Seventy-eight women with pregnancy-induced hypertension were divided into the experimental and the control groups （ n = 39 ）. On the basis of routine spasmolysis and antihypertensive treatment, carbonate chewable tablets and low-dose of enteric-coated aspirin were also administered in the experimental group. We observed and compared the outcome of mothers and fetuses, the changes of mean arterial pressure （ MAP）, 24-hour urinary protein, serum calcium, coagulation and prethrombotie state between the 2 groups. RESULTS： The abnormal fetal heart rates were 7.69% in the experimental group and 23.08% in the control group with significant difference （ P 〈 0.01 ）. The levels of MAP, 24-hour urinary protein and serum calcium were （ 126.2 ± 15.6） mmHg, （3.85 ±0.47） g and （1.83 ±0.41） mmol/L before treatment, and （102.5 ±16.8） mmHg, （1.56±0.63） g and （ 2.44 ± 0.35 ） mmol/L after treatment with statistical difference （ P 〈 0.01 - 0.05 ）. The plasma prothrombin time, fibrinogen, thrombin-antithrombin III complex and D-dimer were （ 10.92 ±0.55） s, （5.8±1.3） g/L, （24.5 ±4.3） mg/L and （1.55 ± 0.46） mg/L before treatment, and （ 11.26 ± 0. 82） s, （ 4.2 ± 0.6） g/L, （9.56±3.7） mg/L and （0.72 ±0.22） mg/L after treatment, which were statistically different （ P 〈 0.01 - 0.05 ）. CONCLUSION： It is effective for the combination of calcium with low-dose of enteric-coated aspirin in treatment of pregnancy- induced hypertension, which can decrease MAP, improve coagulation and prethromobtie state, and the outcome of mothers and fetuses.