不明原因复发性流产的临床治疗方案分析

Treatment in Patients with Unexplained Recurrent Spontaneous Abortion

目的:探讨小剂量阿司匹林、低分子肝素、泼尼松、阿司匹林联合低分子肝素治疗不明原因复发性流产(URSA)的临床效果。方法:回顾性分析2014年1月—2018年4月就诊于安徽医科大学第一附属医院生殖中心连续发生2次及以上妊娠早期自然流产的病因不明患者,因输卵管因素要求通过辅助生殖技术助孕,行人工周期冷冻胚胎移植的患者共1 013例。所有患者均给予同样的人工周期激素替代治疗,对照组(596例)不加用抗凝药物;观察组(417例)再分为单药泼尼松组、单药阿司匹林组、单药低分子肝素组和阿司匹林联合低分子肝素组4个亚组,加用的上述药物均使用到孕12周(成功妊娠的患者)。比较对照组和观察组、观察组各亚组间生化妊娠率、临床妊娠率、流产率及分娩率。结果:观察组与对照组生化妊娠率和早期流产率差异有统计学意义(P<0.05),各组临床妊娠率和分娩率差异无统计学意义(P>0.05)。其中,单药阿司匹林组、单药低分子肝素组及阿司匹林联合低分子肝素组生化妊娠率均高于对照组(P<0.05);单药阿司匹林组、阿司匹林联合低分子肝素组早期流产率均低于对照组(P<0.05)。结论:对于URSA患者实施辅助生殖技术,在人工周期激素替代治疗中,加用抗凝药物至孕12周,可以改善URSA患者的妊娠结局,且低分子肝素的使用对于胚胎着床更有利,确定临床妊娠后加用阿司匹林能更有效地降低早期流产率。因此,URSA患者行人工周期胚胎移植加用抗凝药物治疗值得推荐。

Objective：To investigate the clinical efficiency of aspirin, low molecular heparin,metacortandracin, and aspirin combined with low molecular heparin in patients with unexplained recurrent spontaneous abortion（URSA）. Methods： A total of 1 013 women with URSA who accepted the artificial cycle freezing embryo transfer（FET） were enrolled from January 2014 to April 2018. 596 patients in the control group were not treated with the additional drugs besides the artificial cycle. 417 patients treated with the additional drugs from the menstruation end to the 12 weeks of pregnancy in the experimental group were divided into four subgroups（aspirin, low molecular heparin, metacortandracin and aspirin combined with low molecular heparin）. F test and χ~2 test were used to analyze the differences in the biochemical pregnancy rate, clinical pregnancy rate,early abortion rate and parturition rate. Results： There were significant differences in the biochemical pregnancy rate and early abortion rate between the control group and the experimental group（P〈0.05）. The biochemical pregnancy rate of aspirin subgroup, low molecular heparin subgroup and aspirin combined with heparin subgroup were significantly higher than that in the control group（P〈0.05）. The early abortion rate of aspirin subgroup and the aspirin combined with heparin subgroup were significantly lower than that in the control group（P〈0.05）.However, there were no significant differences in the clinical pregnancy rate and parturition rate between the two groups, and among those subgroups（P〉0.05）. Conclusions： For those patients with URSA undergoing FET, the additional anticoagulant drugs besides the artificial cycle may improve the pregnancy outcomes. The low molecular heparin is helpful for embryo implantation, while aspirin may effectively reduce the rate of early abortion.Therefore, the additional treatment with anticoagulant drugs is worth recommending for those patients with URSA undergoing FET.