低分子肝素治疗复发性流产患者血管相关因子表达变化观测

The effects of low molecular weight heparin on vascular factors of women with recurrent spontaneous abortion

目的探讨低分子肝素(LMWH)在不明原因复发性流产(RSA)患者治疗前后血清中血小板反应蛋白-1(TSP-1)、血管内皮生长因子(VEGF)及其可溶性受体-1(sFLT-1)水平变化情况。方法选择妇科门诊就诊的RSA患者36例,以LMWH治疗作为观察组;31例同期正常产检孕妇为对照组。应用ELISA法检测入组对象TSP-1、VEGF及sFLT-1血清水平,比较两组研究对象变化情况;同时观察LMWH使用过程中不良反应的发生情况。结果 RSA孕6周妇女血清中sFLT-1水平高于同期对照组,TSP-1、VEGF水平低于同期对照组,差异有统计学意义(P<0.05);治疗后,孕8周血清sFLT-1水平较孕6周无变化;高于同期对照组妇女水平;治疗后,孕8周TSP-1、VEGF水平较孕6周增高(P<0.05);低于同期对照组妇女水平,但差异无统计学意义(P>0.05);观察组使用LMWH的36例患者中,3例(8.33%)出现注射部位小面积瘀青,仅1例(2.77%)注射部位疼痛不适。结论 RSA的发生可能与TSP-1、VEGF及sFLT-1的异常表达相关;小剂量LMWH可改善VEGF及sFLT-1的异常表达。

Objective To investigate the expression of thrombospondin-1(TSP-1), vascular endothelial growth factor(VEGF) and soluble fms-like tyrosine kinase-1(sFlt-1) in the women with recurrent spontaneous abortion(RSA) during treatment with low molecular weight heparin(LMWH). Methods Thirty-six women with RSA were enrolled from January 2017 to March 2018, and assigned into therapy group. Thirty-one normal pregnant women during the same period were enrolled in control group. Comparison was conducted between the patients from the 2 groups concerning TSP-1, VEGF and Sflt-1. The adverse reactions during the use of LMWH was also observed. Results The sflt-1 at the 6^th week of pregnancy in therapy group was significantly higher, but TSP-1 and VEGF were significantly lower than those of control group(P<0.05). The sFLT-1 in therapy group was not significantly increased with the pregnancy weeks(P>0.05). The levels of TSP-1 and VEGF in therapy group were significantly increased with the pregnancy weeks(P<0.05). The levels of TSP-1 and VEGF at the 8^th week pregnancy in therapy group were significantly higher than those of at the 6th week(P<0.05). Among 36 cases treated with LMWH, small ecchymoma were found in 3 cases(8.33%), and only one case of light pain in the location of subcutaneous injection.Conclusion The abnormal expressions of sFLT-1, VEGF and TSP-1 affect RSA. Low-dose LMWH is safe and effective in the therapy of pregnant women with RSA.