小剂量阿司匹林对高危孕妇发生子痫前期的预防作用分析

Analysis on preventive efficacy of low dose aspirin on preeclampsia in high risk pregnant women

目的探讨小剂量阿司匹林对高危孕妇发生子痫前期的预防作用。方法前瞻性连续选取2017年6月~2019年12月于惠州市第一妇幼保健院进行围产期保健的孕20周前子痫前期高危孕妇60例,随机分为试验组(n=30)和对照组(n=30)。对两组加强监测干预,此外,试验组入组后每天晚上睡前予以100mg/d阿司匹林口服至妊娠36周。两组均随访至妊娠结局,统计比较两组子痫前期发生率及母婴结局。检测比较两组阿司匹林给药前和妊娠36周的血小板/淋巴细胞比率(PLR)和中性粒细胞/淋巴细胞比率(NLR)等炎症指标及凝血功能指标变化。并分析试验组炎症指标水平和凝血功能指标与子痫前期的关系。结果与对照组比较,试验组子痫前期发生率及不良母婴结局总发生率均降低,妊娠36周的炎症指标水平降低,妊娠36周的凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)延长(P<0.05)。与同组给药前比较,试验组妊娠36周的炎症指标降低,妊娠36周的PT和APTT延长(P<0.05)。与试验组未发生子痫前期的孕产妇比较,其出现子痫前期孕产妇不良母婴结局总发生率升高,炎症指标水平升高,而PT和APTT则缩短(P<0.05)。试验组炎症指标、PT和APTT与其子痫前期发生率均密切相关(P<0.05)。结论长期小剂量阿司匹林口服可有效预防高危孕妇子痫前期的发生并改善母婴结局,而控制炎症反应和调节凝血功能可能为其预防子痫前期的机制。

Objective To investigate the preventive efficacy of low dose aspirin on preeclampsia in high risk pregnant women.Methods A total of 60 pregnant women with high risk of preeclampsia before the 20th week of pregnancy who were undergoing perinatal nursing in Huizhou No.1 Maternal and Child Care Service Center from June 2017 to December 2019 were selected continuously and prospectively and randomly divided into the experimental group(n=30)and the control group(n=30).The monitoring interventions were strengthened in the two groups.In addition,after inclusion,the experimental group received 100mg/d aspirin taken orally every night before going to bed until the 36th week of pregnancy.Both groups were followed up to pregnancy outcomes,and the incidence of preeclampsia and maternal and infant outcomes were compared statistically.The changes of platelet/lymphocyte ratio(PLR),neutrophil/lymphocyte ratio(NLR)and other inflammatory indexes and coagulation function indexes before aspirin administration and at the 36th week of pregnancy were detected and compared between the two groups.The relationship between inflammation and coagulation function index level and preeclampsia in the experimental group was analyzed.Results Compared with the control group,the incidence rate of preeclampsia and total adverse maternal and infant outcomes in the experimental group reduced,the level of inflammatory index decreased,and the prothrombin time(PT)and activated partial thromboplastin time(APTT)prolonged(P<0.05).Compared with that in the same group before aspirin administration,the inflammation index decreased at the 36th week of pregnancy,while PT and APTT prolonged at the 36th week of pregnancy(P<0.05).Compared with the maternal without preeclampsia in the experimental group,the incidence rate of total adverse maternal and infant outcomes and the level of inflammatory index in the maternal with preeclampsia were higher,while PT and APTT were shorter(P<0.05).Inflammation index,PT and APTT were closely related to the incidence rate of preeclampsia in the experimental group(P<0.05).Conclusion Long-term oral administration of low dose aspirin can effectively prevent the occurrence of preeclampsia in high risk pregnant women and improve maternal and infant outcomes,Controlling inflammatory reaction and regulating coagulation function may be the mechanism of preventing preeclampsia.