抗凝治疗URSA的有效性及安全性及其对外周血PAI-1和t-PA的影响

The clinical efficacy and safety of anticoagulant therapy in the treatment of URSA and its effects of t-PA and PAI-1 on the peripheral blood

目的探究抗凝药物在治疗不明原因的复发性流产(URSA)上的临床效果、安全性以及对其外周血纤溶酶原激活物抑制剂1(PAI-1)和组织型纤溶酶原激活物(t-PA)的影响。方法将我院妇产科收治的93例URSA患者按照入院的先后顺序分为常规组和抗凝组,治疗前记录比较2组患者的临床资料。常规组患者给予常规药物进行治疗,抗凝组患者则在此基础上给予低分子肝素联合阿司匹林进行治疗。治疗前后,对比2组患者的凝血4项检查结果以及血浆PAI-1和t-PA的变化情况,同时比较分析两组患者的妊娠结局以及不良反应发生情况。结果治疗前后,抗凝组和常规组患者的凝血4项检查结果比较,差异无统计学意义(P>0.05)。常规组患者治疗前后血浆t-PA和PAI-1,差异无统计学意义(P>0.05);抗凝组患者治疗后的PAI-1水平明显低于治疗前,差异有统计学意义(P<0.05),治疗后的t-PA水平差异无统计学意义(P>0.05)。抗凝组患者的活产率为87%,常规组患者的活产率为65%,2组差异有统计学意义(P<0.05)。抗凝组的不良反应发生率为7%,常规组为10%,2组差异无统计学意义(P>0.05),临床用药安全性良好。结论在治疗URSA上,抗凝治疗的临床效果优于常规治疗,能够有效缓解URSA患者的血液高凝状态,改善其妊娠结局,妊娠活产率得到显著提高,且临床用药安全可靠,值得在临床上积极推广。

Objective To study the clinical effect and safety of anticoagulant drugs on the treatment of URSA and their effect on t-PA and PAI-1in the peripheral blood.Methods According to the order of admission,93 cases of URSA patients in out hospital were divided into the conventional group and the anticoagulant group.Before treatment,we recorded and compared the clinical data of two groups of patients.The conventional group was treated with conventional drugs.On the basis of this,the anticoagulant group was treated with low molecular weight heparin combined with aspirin.Before and after treatment,we compared the two groups of patients for four blood coagulation examination results and the changes of plasma PAI-1and t-PA.At the same time,we compared and analyzed pregnancy outcome and adverse reactions of the two groups.Results Before and after treatment,there was no significant difference between the four coagulation test results in the anticoagulant group and the conventional group,respectively（P〉0.05）.Before and after treatment,there was no significant difference in plasma t-PA and PAI-1in the conventional group（P〉0.05）;the level of PAI-1in patients of anticoagulant group was significantly lower than that before treatment,the difference was statistically significant（P〈0.05）;the level of t-PA was higher than that before treatment,but the difference was not statistically significant（P〉0.05）.The live-birth rate was 87%in the anticoagulant group,and that was 65%in the conventional group.The difference was statistically significant（P〈0.05）between the two groups.On the safe aspect,the adverse reaction rate was7%in the anticoagulant group and 10%in the conventional group.The difference was not statistically significant（P〉0.05）,and the clinical medication safety was great.Conclusion In the treatment of URSA,the clinical effect of anticoagulant therapy is better than that of conventional treatment,it can alleviate the high blood coagulation state effectively in patients with URSA and improve the outcome of pregnancy.The live-birth rate is significantly improved.It is safe and reliable.It is worth promoting in clinical practice.