丹参川芎嗪联合甲基多巴对妊娠期高血压妇女及胎盘血流相关指标的影响

Effect of Ligustrazine combined with methyldopa on blood rheology and placental bed artery hemodynamics in women with hypertensive disorder complicating pregnancy

目的分析川芎嗪联合甲基多巴对妊娠期高血压(HDCP)妇女血液流变学和胎盘床动脉血流动力学的影响。方法选取2015年1月～2017年9月在陕西省人民医院接受治疗的HDCP患者180例,按分层随机法设为观察组(n=90)与对照组(n=90),对照组给予甲基多巴治疗,观察组联合丹参川芎嗪治疗,对比两组患者血压、尿蛋白表达、血液流变学、胎盘床动脉血流动力学变化情况及妊娠结局,并统计不良反应发生率。结果治疗4周后,两组收缩压(SBP),舒张压(DBP),24 h尿蛋白,尿钙黏蛋白,尿激肽原-1,高切、中切、低切全血黏度及全血还原度,搏动指数(PI),阻力指数(RI),收缩期最大速度/舒张末期最大速度(S/D)均下降,且观察组低于对照组;时间平均流速(TAV)均上升,观察组高于对照组,差异均有统计学意义(P <0.05)。同时,观察组新生儿体重、分娩孕周高于对照组,不良妊娠结局发生率低于对照组,差异均有统计学意义(P <0.05)。两组药物不良反应症状比较,差异无统计学意义(P> 0.05)。结论丹参川芎嗪联合甲基多巴治疗HDCP对血液流变学、胎盘床血流动力学的改善更显著,可取得更佳的降压及尿蛋白控制获益,于改善妊娠结局有重要意义,且不增加药物不良反应风险。

Objective To analyze the effect of Ligustrazine combined with methyldopa on blood rheologyand placental bed artery hemodynamics in women with hypertensive disorder complicating pregnancy （HDCP）. Methods 180 patients with HDCP who received treatment in the hospital from January 2015 to September 2017 were randomly divided into the combined group （n=90） and the control group （n=90）.The control group was treated with methyldopa,while the observation group was treated with Danshen Ligustrazine combined with methyldopa. The blood pressure,expression of urine protein,blood rheology,placental bed artery hemodynamic changes and pregnancy outcomes were compared between the two groups. The incidence of adverse reactions was statistically analyzed. Results After 4 weeks of treatment,the systolic blood pressure （SBP）,diastolic blood pressure（DBP）,24h urinary protein,urine E-cadherin,urine kininogen,high shear,medium shear and low shear whole blood viscosity,whole blood reduction degree,pulsation index （PI）,resistance index （RI）,peak systolic velocity / peak end diastolic velocity （S/D） in the two groups were decreased. Besides,the above indexes in the observation group were lower than those in the control group. The time averaged flow velocity （TAV） increased after treatment,and it in the observation group was higherthan that in the control group. The birth weight and gestational weeks of delivery in the observation group were larger than those in the control group. The incidence of adverse pregnancy outcomes in the observation groupwas lower than that in the control group （P 〈 0.05） ,but there was no significant difference between the two groups in adverse drug reactions （P 〉 0.05）. Conclusion Ligustrazine combined with methyldopa can significantly improve the blood rheology and placental bed artery hemodynamics, lower the blood pressure and control urine protein in women with HDCP,which is of great significance on improving pregnancy outcomes. It will not increase the risk of adverse drug reactions.