低分子肝素治疗妊娠期高血压疾病后母体内皮损伤及胎盘病理损伤的评估

Effect of low molecular weight heparin therapy on maternal endothelial injury and placental pathological injury after hypertensive disorder complicating pregnancy

目的:探讨低分子肝素治疗对妊娠期高血压疾病后母体内皮损伤及胎盘病理损伤的影响。方法:选择2014年9月~2016年5月间在本院接受治疗的妊娠期高血压疾病患者70例,按照随机数表法将其分为对照组、观察组,各35例。对照组患者接受常规治疗,观察组患者接受低分子肝素联合常规治疗,均持续至分娩前,对比两组患者血清中内皮损伤指标,胎盘组织碾磨液中氧化应激指标含量、凋亡分子表达量的差异。结果:治疗后,两组患者血清中内皮素(ET)、血管细胞黏附分子-1(VCAM-1)的含量低于治疗前,一氧化氮(NO)、前列腺素E(PGE)含量高于治疗前,且观察组患者血清中ET、VCAM-1的含量低于对照组患者,NO、PGE的含量高于对照组患者,差异均有统计学意义(P<0.05);分娩后,胎盘组织碾磨液中晚期氧化蛋白产物(AOPP)、丙二醛(MDA)的含量显著低于对照组患者,超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)的含量高于对照组患者,差异均有统计学意义(P<0.05);胎盘组织碾磨液中Fas、p53、caspase-3mRNA的表达量低于对照组患者,Bcl-2、bax mRNA的表达量高于对照组患者,差异均有统计学意义(P<0.05)。结论:妊娠期高血压疾病患者接受低分子肝素辅助治疗,有助于减轻母体内皮损伤、减轻全身氧化应激程度、抑制胎盘细胞凋亡。

Objective： To study the effect of low molecular weight heparm therapy on maternal enaomenal injury ann placental pathological injury after hypertensive disorder complicating pregnancy. Methods： A total of 70 patients with hyperten- sive disorder complicating pregnancy who were treated in the hospital between September 2014 and May 2016 were divided into control group and observation group according to the random number table method, 35 cases in each group. Control group re ceived conventional therapy, the observation group received low molecular weight heparin combined with conventional therapy, and both therapies lasted until delivery. The differences in the levels of endothelial injury indexes in serum as well as the expres- sion of oxidative stress indexes and apoptosis molecules in the placental grinding fluid were compared between the two groups of patients. Results： After treatment, serum ET and VCAM 1 levels of both groups of patients were significantly lower than those before treatment while NO and PGE levels were higher than those before treatment, and serum ET and VCAM-1 levels of observation group were significantly lower than those of control group while NO and PGE levels were higher than those of control group （P〈0.05） ; after delivery, AOPP and MDA levels in placental grinding fluid were significantly lower than those of control group while SOD and GSH-Px levels were higher than those of control group （P〈0.05）; Fas, p53 and easpase-3 mRNA expression in placental grinding fluid were significantly lower than those of control group while Bcl-2 and bax mRNA expression were higher than those of control group （P〈0.05）. Conclusion.. Adjuvant low molecular weight heparin therapy can help to reduce the maternal endothelial injury, reduce the systemic oxidative stress and suppress the placental cell apoptosis in patients with hypertensive disorder complicating pregnancy.