依诺肝素钠对早发型重度子痫前期患者胎盘生长因子、25-羟基维生素D、D-二聚体的影响

The effect of enoxaparin sodium on PIGF,25-hydroxy vitamin D and D-dimer in patients with early onset severe preeclampsia

目的观察依诺肝素钠对早发型重度子痫前期患者胎盘生长因子(PIGF)、25-羟基维生素D(25-OHVD)、D-二聚体的影响。方法 2014年9月—2015年8月武汉市第一医院产科收治早发型重度子痫前期患者80例,随机数字表法分为观察组和对照组,每组40例。对照组采取常规治疗,观察组在此基础上加以依诺肝素钠进行治疗。比较患者治疗前后血脂指标、抗凝血酶-Ⅲ(AT-Ⅲ)、尿蛋白定量、PIGF、25-OH-VD、可溶性血管内皮生长因子受体-1(sFlt-1)、D-二聚体、P-选择素、血管性假血友病因子(vWF)水平,记录患者分娩结局及并发症发生率。结果治疗后,观察组患者的总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)低于对照组[(6.87±1.12)mmol/L vs.(7.56±1.34)mmol/L,(4.15±0.65)mmol/L vs.(5.32±0.75)mmol/L,(4.03±0.87)mmol/L vs.(5.12±0.97)mmol/L,P<0.05],而高密度脂蛋白胆固醇(HDL-C)高于对照组[(1.97±0.32)mmol/L vs.(1.76±0.31)mmol/L,P<0.05]。观察组患者的AT-Ⅲ和尿蛋白定量低于对照组[(65.89±11.02)%vs.(72.32±11.05)%,(1.22±0.15)g/24h vs.(1.56±0.24)g/24h,P均<0.05]。观察组患者的PIGF、25-OH-VD高于对照组[(55.87±12.15)pg/ml vs.(46.54±10.54)pg/ml,(35.26±5.68)ng/ml vs.(26.05±4.58)ng/ml,P均<0.01];D-二聚体、sFlt-1、vWF、p-选择素低于对照组[(280.69±32.15)ng/ml vs.(360.54±42.15)ng/ml,(1068.75±108.11)pg/ml vs.(1 354.56±126.44)pg/ml,(965.25±86.57)U/L vs.(1 205.54±103.54)U/L,(98.54±9.57)ng/ml vs.(126.54±12.54)ng/ml,P均<0.01]。2组患者的平均出血量、新生儿体质量、妊娠终止孕周、剖宫产率差异无统计学意义(P>0.05)。观察组并发症总发生率为25.0%(10/40),对照组为55.0%(22/40),2组比较差异有统计学意义(P<0.05)。结论依诺肝素钠能明显改善早发型重度子痫前期患者PIGF、25-OH-VD、D-二聚体、AT-Ⅲ、及血脂等指标,具有较低的并发症发生率,安全有效。

Objective To investigate the effect of enoxaparin sodium on PIGF,25-hydroxy vitamin D and D-dimer in patients with early onset severe preeclampsia.Methods From September 2014 and August 2015,selecting 80 patients with early onset severe preeclampsia in Wuhan First Hospital obstetrics,they were divided into the observation group 40 cases and control group 40 cases by random number table method.Control group was treated with conventional therapy,while observation group was given Enoxaparin Sodium on the basis of control group.The levels of blood lipid index,antithrombin Ⅲ（AT-Ⅲ）,urine protein quantitation,placental growth factor（PIGF）,25-hydroxyitamin D（25-OH-VD）,soluble vascular endothelial growth factor receptor 1（sFlt-1）,D-dimer（D-dimer）,P-select element（P-selection）,false von willebrand factor（vWF）in patientsbefore and after treatment were compared,the patient＇s birth outcomes and incidence of complications were recorded.Results After treatment,the total cholesterol（TC）,triglycerides（TG）,low density lipoprotein cholesterol（LDL-C） of observation group patients were lower than the control group[（6.87 ± 1.12） mmol/L vs.（7.56 ± 1.34） mmol/L,（4.15 ±0.65） mmol/Lvs.（5.32 ±0.75） mmol/L,（4.03 ±0.87） mmol/L vs.（5.12 ±0.97） mmol/L,P〈0.05],whereas the level of high-density lipoprotein cholesterol（HDL-C） was higher than that in the control group[（1.97 ± 0.32） mmol/L vs.（1.76 ±0.31）mmol/L,P〈0.05].The AT-Ⅲ and urine protein quantitationof observation group patients were obviously lower than the control group[（65.89 ±11.02）%vs.（72.32 ± 11.05）%,（1.22 ±0.15）g/24 h vs.（1.56±0.24） g/24 h,P〈0.05].The PIGF,25-OH-VD of observation group patients were higher than the control group[[（55.87 ± 12.15） pg/ml vs.（46.54±10.54） pg/ml,（35.26 ±5.68） ng/ml vs.（26.05±4.58） ng/ml,P〈0.01],D-dimer,sFlt-1,vWF,P-selection were significantly lower than control group[[（280.69 ±32.15） ng/ml vs.（360.54 ±42.15） ng/ml,（1 068.75 ±108.11） pg/ml vs.（1 354.56 ±126.44）pg/ml,（965.25 ±86.57） U/L vs.（1 205.54 ±103.54）U/L,（98.54 ±9.57） ng/ml vs.（126.54 ± 12.54） ng/ml,P〈0.01].There were no differences in average blood loss,newborn body quality,termination of pregnancy gestational age and cesarean section rate between the two groups（P〉0.05）.The total incidence of complications rate of observation group was 25.0%（10/40） had significant differences with control group 55.0%（22/40） there was significant difference between the two groups（P〈0.05）.Conclusion Enoxaparin sodium can obviously improve PIGF,25-OH-VD,D-dimer,the AT-Ⅲ,and blood lipids index of early onset severe preeclampsia patients,with a lower incidence of complications,belong to the safe and effective drugs.