肝素治疗反复妊娠丢失伴抗磷脂抗体阳性孕妇的疗效观察

Study of heparin on pregnant woman with recurrent pregnant loss and positive anti-phospholipid antibody

目的探讨肝素治疗因抗磷脂抗体所致反复性妊娠丢失及对孕妇血液中抗体的影响。方法记录门诊接诊的狼疮抗凝抗体(LA)和/或抗心磷脂抗体(ACA)阳性的反复性妊娠丢失患者(排除遗传、感染、内分泌及子宫附件异常等可导致流产的因素),选取54例再次妊娠患者,前瞻性的随机分为两组,各27例,分别予肝素(肝素组)和强的松加小剂量阿司匹林(对照组)治疗,观察比较两组的妊娠结局和治疗后LA和ACA的量。结果肝素组27例,足月产27例,早产4例,流产2例,活产率92.6%,抗体清除率71.4%。对照组27例,足月产13例,早产8例,流产6例,活产率77.8%,抗体清除率35.7%。活产率差异无显著性(P>0.05),抗体清除率差异有统计学意义(P<0.01)。结论肝素对抗磷脂抗体所致的反复妊娠丢失治疗效果肯定,并能有效清除抗磷脂抗体。

Objective To evaluate the effect of heparin on women with recurrent pregnant loss with positive anti-phospholipid antibody and its influence on these antibodies serum level.Methods fifty-seven patients with recurrent pregnancy loss were randomized to receive aspirin and prednisone（control group） and heparin（study group）.Those caused by other factors such as heredity,infection,endocrine system and uterus and appendixes but with positive lupus anticoagulant（LA） or/and anti-cardiolipin antibodies（ACA） were excluded.Pregnant outcome and the level of LA and ACA before and after medication were observed.Results In study group,21 delivered at full term,4 premature births,2 abortion.The rate of live birth was92.6% with no difference to that of control group[77.8%（P0.05）].The rate of antibody elimination（71.4%）was significantly higher than that of control group[35.7（P0.01）].Conclusion Heparin is effective in managing recurrent pregnant loss due to positive anti-phospholipid antibodies and reducing serum antibody level.