低分子肝素治疗复发性流产患者凝血及血液流变学状态观察

Observation of coagulation and hematological status in RSA patients treated with LMWH

目的探讨不明原因复发性流产(recurrent spontaneous abortion,RSA)患者凝血功能和血液流变学状况及低分子肝素(low molecular weight heparin,LMWH)在RSA患者妊娠中的临床应用。方法选择2018年于广州市花都区人民医院及广州市妇女儿童医疗中心妇科门诊就诊的RSA患者30例,以LMWH治疗作为治疗组;30例同期正常产检孕妇为对照组。比较血浆D-二聚体(D-dimer,D-D),凝血酶原时间(prothrombin time,PT),部分活化凝血酶时间(activated partial thromboplastin time,APTT)变化情况;比较两组血液流变学变化情况;同时观察治疗组LMWH使用过程中不良反应的发生情况。结果孕前、孕6周及孕8周时,治疗组D-D数值较同期对照组高;组内比较随着孕周增加而增加;孕前PT,APTT均较正常组低,差异均有统计学意义(P<0.05);孕6周及孕8周时,治疗组患者的PT,APTT数值,与对照组比较,差异无统计学意义(P>0.05);孕前治疗组和对照组两组间全血比黏度、全血还原比黏度、血浆比黏度血液流变学指标比较,差异均有统计学意义(P<0.05)。孕6周及8周时,治疗组血液流变学的各项异常指标治疗后与对照组比较,差异无统计学意义(P>0.05);治疗组使用LMWH的30例患者中5例出现脐周注射部位皮下小面积瘀青,发生率为16.67%(5/30)。仅1例患者出现皮下注射部位轻度疼痛不适感,发生率为3.33%(1/30)。结论小剂量LMWH能安全有效地改善RSA患者凝血及血液流变学状态。

Objective To explore the coagulation and hematological status and clinical application of low molecular weight heparin(LMWH)in pregnant women with recurrent spontaneous abortion(RSA).Methods Thirty cases of RSA patients attending gynecological outpatient clinic at Huadu District People's Hospital of Guangzhou and Guangzhou Women and Children Medical Center in 2018 were selected as treatment group with LMWH treatment;30 cases of pregnant women undergoing normal obstetric examination at the same time were selected as control group.To compare the changes in plasma D-dimer(D-D),prothrombin time(PT),and activated partial thromboplastin time(APTT);to compare the blood rheology of the two groups;and to observe the occurrence of adverse reactions during LMWH use in the treatment group.Results The D-D values in the pre-pregnancy,6 weeks and 8 weeks were higher in the treatment group than in the control group;the intra-group comparison increased with increasing gestation weeks;the pre-pregnancy PT and APTT were lower than the control group,and the differences were statistically significant(P<0.05);the PT and APTT values in the treatment group were not statistically different(P>0.05)when compared with the control group at 6 weeks and 8 weeks;the differences in the whole blood ratio viscosity,whole blood reduction ratio viscosity and plasma ratio blood rheology indicators pre-pregnancy between the treatment group and the control group were statistically significant(P<0.05).At 6 and 8 weeks of gestation,there was no statistical difference of the abnormal blood rheology indicators between the treatment group after the treatment and the control group;5 out of 30 patients who used LMWH in the treatment group had small subcutaneous bruising at the injection site of the umbilical cord,and the incidence was 16.67%(5/30).Mild painful discomfort at the subcutaneous injection site occurred in only 1 patient with an incidence of 3.33%(1/30).Conclusion Small doses of LMWH can safely and effectively improve coagulation and hematological status in patients with RSA.