低分子肝素干预对妊娠期高血压疾病母体不良妊娠结局的影响

Effect of low molecular heparin on maternal adverse pregnancy outcomes of hypertensive disorder complicating pregnancy

目的研究低分子肝素干预对不良妊娠结局严重程度和复发率的影响,并试图通过以血栓形成倾向为变量的亚组分析探究其具体机制。方法共有128例符合标准的患者纳入研究,其中100例同时具有母体不良妊娠结局以及胎儿发育异常的病史,28例具有单纯的母体不良妊娠结局病史。招募后予以依诺肝素预防剂量治疗,统计研究对象的病史等基线数据,交叉分析干预后胎儿生长受限、妊娠期高血压、子痫前期、HELLP综合征以及胎盘早剥的复发情况,统计孕32周内医源性分娩(严重不良妊娠结局)的发生情况。结果接受依诺肝素治疗的平均时长为20周,严重不良妊娠结局发生率由既往妊娠的45%降至治疗后的4%。在亚组分析中,具有先天性血栓形成倾向组与无先天性血栓形成倾向组,两组间不良妊娠结局的再发率和严重程度无统计学意义(P>0.05)。不良妊娠结局的总体复发率为28%。在既往同时具有母体不良妊娠结局以及胎儿发育异常的患者亚组中,严重妊娠结局者新生儿体重在治疗后明显改善,治疗前为855 g(530~1 150)g,治疗后为1 095 g(1 030~1 140)g,差异具有统计学意义(P<0.05)。结论预防性剂量的依诺肝素可以显著降低不良妊娠结局的复发率和严重程度。

Objective To research the effect of low molecular heparin on severity and recurrence rate of adverse pregnancy outcomes,explore the specific mechanism through subgroup analysis with thrombophilia as the variable.Methods A total of 128 patients meeting the inclusion criteria were included in the study,including 100 patients with maternal adverse pregnancy outcomes history and fetal developmental abnormalities history and 28 patients with simple maternal adverse pregnancy outcomes history.The patients were treated by prophylactic dose of enoxaparin,the baseline data was analyzed statistically.The recurrence rates of fetal growth restriction（FGR）,hypertensive disorder complicating pregnancy（HDCP）,preeclampsia,HELLP syndrome,and placental abruption after intervention were analyzed by crossover analysis,the incidence rate of severe adverse pregnancy outcomes of iatrogenic delivery within 32 gestational weeks was analyzed statistically.Results The mean gestational age during enoxaparin treatment was 20 weeks.The incidence rate of severe adverse pregnancy outcomes decreased from 45% before treatment to 4% after treatment.Subgroup analysis showed that there was no statistically significant difference in the recurrence rate and severity of adverse pregnancy outcomes between congenital thrombophilia group and non-thrombophilia group（P〉0.05）.The total recurrence rate of adverse pregnancy outcomes was 28%.In maternal adverse pregnancy outcomes complicated with fetal developmental abnormalities group,neonatal weight in patients with adverse pregnancy outcomes was improved significantly,there was statistically significant difference between before treatment [855 g（530-1 150） g] and after treatment [1 095 g（1 030-1 140） g]（P〈0.05）.Conclusion Prophylactic dose of enoxaparin can significantly reduce the recurrence rate and severity of adverse pregnancy outcomes.