低分子肝素治疗妊娠期D-二聚体异常升高疗效观察

Clinical Effect of Low Molecular Weight Heparin in the Treatment of Pregnant Women with Abnormal Increase of D-Dimer

目的探讨低分子肝素抗凝治疗妊娠期D-二聚体异常升高的临床效果及对其分娩结局的影响。方法选择医院2015年4月至2017年7月收治的妊娠期D-二聚体异常升高患者50例,按随机数字表法分为对照组和观察组,各25例。对照组患者采用常规保胎治疗,观察组患者在对照组治疗基础上联合低分子肝素钠治疗。采集两组患者的绒毛组织,经甲醛固定后行苏木精-伊红(HE)染色法进行染色;采用比浊法测定两组患者的D-二聚体、凝血酶原时间、凝血酶时间、活化部分凝血活酶时间和纤维蛋白原水平。结果观察组患者停药后D-二聚体、凝血酶原时间、凝血酶时间、活化部分凝血活酶时间和纤维蛋白原水平均低于对照组(P<0.05);HE染色结果表明,两组患者组织结构清晰度存在明显差异(P<0.05),观察组患者组织结构完整,未见水肿,对照组患者绒毛组织结构存在一定缺损,且可见少许炎性因子、水肿发生;与对照组比较,观察组患者早产、足月产发生率均高于对照组(P<0.05);观察组流产发生率低于对照组(P<0.05);观察组患者治疗后并发症发生率与对照组比较无明显差异(P>0.05)。结论低分子肝素抗凝治疗妊娠期D-二聚体异常升高疗效好,有助于改善患者凝血因子水平,可改善分娩结局,且药物安全性较高,值得临床推广。

Objective To investigate the clinical effect of low molecular weight heparin anticoagulant in the treatment of pregnant women with abnormal increase of D-dimer and its effect on delivery outcome. Methods Totally 50 pregnant women with abnormal increase of D-dimer admitted to our hospital from April 2015 to July 2017 were divided into the control group and the observation group according to the random number table method,25 cases in each group. The control group was treated with conventional tocolytic therapy,on this basis,the observation group was treated with low molecular weight heparin sodium. The villus tissues of the two groups were collected and stained with hematoxylin-eosin（ HE） staining after formaldehyde fixation. The D-dimer,prothrombin time,thrombin time,activated partial thromboplastin time and fibrinogen level in the two groups were determined by turbidimetry. Results After drug withdrawal,the D-dimer,prothrombin time,thrombin time,activated partial thromboplastin time and fibrinogen level in the observation group were lower than those in the control group（ P〈0. 05）. The results of HE staining showed that there was a significant difference in the clarity of tissue structure between the two groups（ P〈0. 05）. The histological structure of the observation group was intact and no edema was found. There was a certain defect in the villus tissue structure in the control group,with a few inflammatory factors and edema. The rates of preterm and term monthly in the observation group were higher than those in the control group（ P〈0. 05）. The abortion rate in the observation group was lower than that in the control group（ P〈0. 05）. The incidence rates of complication in the observation group were not significantly different from those in the control group（ P〈0. 05）. Conclusion Low molecular weight heparin anticoagulation in the treatment of pregnant women with abnormal increase of D-dimer has a good effect,which can help to improve the level of blood coagulation factors,improve the delivery outcome,it has higher safety,which is worthy of clinical promotion.