低分子肝素钠对D-二聚体异常升高复发性流产孕妇Toll样受体4及核因子-Kappa B p65表达的影响

Effect of low-molecular-weight heparin sodium on expressions of Toll-like receptor 4 and nuclear factor-Kappa B p65 in recurrent spontaneous abotion women with abnormal increase of D-dimer

目的探讨低分子肝素钠对D-二聚体(D-D)异常升高复发性流产(RSA)孕妇Toll样受体4(TLR4)及核因子-Kappa B p65(NF-κB p65)表达的影响,为临床诊疗提供实践依据。方法选取2013年1月-2015年1月收入该院的108例D-D异常升高RSA孕妇为研究对象,根据随机数字表法分为观察组和对照组,每组各54例。对照组接受传统保胎治疗,观察组在传统保胎治疗基础上予以低分子肝素钠联合治疗。分析比较两组患者的临床治疗效果、TLR4及NF-κB p65的m RNA及蛋白表达水平以及不良反应等指标的差异。结果观察组临床总有效率(83.33%)明显高于对照组(64.81%),差异具有统计学意义(χ~2=4.820,P<0.05);观察组绒毛组织结构完整、清晰,蜕膜腺体高度分泌,未见蜕膜组织水肿变性以及炎性细胞浸润,中间型滋养细胞无明显增生,滋养细胞未见变性、坏死;经不同方案治疗后,观察组患者TLR4和NF-κB p65的m RNA表达水平及蛋白表达含量明显低于对照组,差异具有统计学意义(t=5.571、11.364;10.663、10.134,P<0.05);两组患者治疗过程中所出现不良反应发生率差异无统计学意义(χ2=0.380,P>0.05)。结论低分子肝素钠联合传统保胎用于治疗D-D异常升高RSA疗效显著,能够显著降低绒毛组织的TLR4及NF-κB p65表达,提高临床治疗成功率,不良反应发生率较低,安全性好,临床上值得推广应用。

Objective To explore the effect of low-molecular-weight heparin sodium on expressions of Toll-like receptor 4 （TLR4） and nuclear factor-Kappa B 1365 （NF-κB p65 ） in recurrent spontaneous abotion （RSA） women with abnormal increase of D-dimer （D- D） , and provide a practical basis for clinical diagnosis and treatment. Methods A total of 108 RSA women with abnormal increase of D- D treated in the hospital from January 2013 to January 2015 were selected as research object, then they were divided into control group and observation group according to random mlmber table, 54 women in each group. The women in control group were treated by traditional therapy, and the women in observation group were treated by low-molecular-weight heparin sodium based on traditional therapy. The clinical curative effects, the expression levels of TLR4 and NF-κB p65 mRNA and proteins, and adverse reactions in the two groups were compared and analyzed. Results The total clinical effective rate in observation group was 83.33% , which was statistically significantly higher than that in control group （64. 81% ） （χ^2 =4. 820, P〈0. 05） ; the villous structure in observation group was intact and clear, the secretion of decidual glands was active, no edema, degeneration and infiltration of inflammatory cells, significant proliferation of intermediate trophoblasts, degen- eration and necrosis of trophoblasts was found. After treated by different regimens, the expression levels of TLR4 and NF-κB 1365 mRNA and proteins in observation group were statistically significantly lower than those in control group （t = 5. 571, 11. 364, P〈0.05; t = 10. 663, 10. 134, P〈0. 05 ） . There was no statistically significant difference in the incidence rates of adverse reactions between the two groups （χ^2= 0. 380, P〉0. 05 ） . Conclusion The curative effect of low-molecular-weight heparin sodium combined with traditional therapy in treatment of RSA women with abnormal increase of D-D is significant, the therapy can significantly reduce the expressions of TLR4 and NF-κB p65 in villous tissue and improve successful rate of clinical treatment, the incidence rate of adverse reactions is low, and the safety is good, which is worthy of clinical promotion and application.