免疫球蛋白联合低分子肝素治疗反复自然流产疗效及血清MCP-1、CCL2、CCR4变化

The effect of immunoglobulin combined with low molecular weight heparin for treating women with recurrent spontaneous abortion and the changes of their serum MCP-1,CCL2 and CCR4 levels

目的:分析免疫球蛋白联合低分子肝素治疗反复自然流产疗效及血清CC型趋化因子配体2(CCL2)、CC趋化因子受体4(CCR4)变化。方法:选取2018年3月—2019年3月本院治疗的反复自然流产患者92例。按照简单随机数表法分为观察组(47例)和对照组(45例),对照组采用叶酸治疗,观察组在对照组基础上采用免疫球蛋白联合低分子肝素治疗。观察两组子宫血流动力学,人绒毛膜促性腺激素(β-hCG)、孕酮(P)、雌二醇(E2)水平,MCP-1、CCL2、CCR4水平,妊娠结局、并发症及不良反应。结果:治疗后,观察组血流动力学指标PI(1.90±0.13)、RI(0.76±0.11)、S/D(3.98±0.51)均低于对照组(2.21±0.27、0.82±0.13、5.17±0.78),β-hCG(7620.17±321.46U/L)、P(78.39±13.96μg/L)、E2(630.16±95.92ng/L)水平均高于对照组(6031.60±267.39U/L、60.71±11.68μg/L、531.07±86.28ng/L),MCP-1(115.27±26.59ng/ml)、CCL2(62.57±5.36pg/ml)、CCR4(75.85±15.08ng/L)均低于对照组(132.96±30.61ng/ml、71.49±6.28pg/ml、 91.57±18.09ng/L),活产率(83.0%)高于对照组(62.2%),不良反应总发生率(17.0%)低于对照组(42.2%)(均P<0.05)。结论:免疫球蛋白联合低分子肝素治疗可更有效改善反复自然流产患者的临床症状,调节雌孕激素水平,降低血清MCP-1、CCL2、CCR4水平及子宫血流动力学指标,提高免疫功能,促进良好的妊娠结局。

Objective: To study the effect of immunoglobulin combined with low molecular weight heparin for treating women with recurrent spontaneous abortion(RSA), and to analyze the changes of their levels of serum monocyte chemotactic protein-1(MCP-1), CC chemokine ligand 2(CCL2) and CC chemokine receptor 4(CCR4). Methods: 92 women with RSA were selected as research objects from March 2018 to March 2019. According to random number table, these women were divided into observation group(n=47) and control group(n=45). The women in the control group were treated with folic acid, while the women in the observation group treated with immunoglobulin combined with low molecular weight heparin except to folic acid. The uterine hemodynamics, the levels of human chorionic gonadotropin(β-hCG), progesterone(P), estradiol(E2), MCP-1, CCL2, and CCR4, the pregnancy outcomes, and the rates of complications and adverse reactions of the women were compared between the two groups. Results: After treatment, the values of PI, RI and S/D of uterine hemodynamics of the women in the observation group were 1.90±0.13, 0.76±0.11, and 3.98±0.51, which were significant lower than those(2.21±0.27, 0.82±0.13, and 5.17±0.78) of the women in the control group. The levels of β-HCG, P, and E2 of the women in the observation group were 7620.17±321.46 U/L, 78.39±13.96μg/L, and 630.16±95.92 ng/L, which were significant higher than those(6031.60±267.39 U/L, 60.71±11.68μg/L, 531.07±86.28 ng/L) of the women in the control group. The levels of MCP-1, CCl2, and CCR4 of the women in the observation group were 115.27±26.59 ng/mL, 62.57±5.36 pg/mL, and 75.85 ±15.08 ng/L,which were significant lower than those(132.96±30.61 ng/mL,71.49±6.28 pg/mL,and 91.57±18.09 ng/L)of the women in the control group.The live birth rate(83.0%)of the women in the observation group was significant higher than that(62.22%)of the women in the control group,but the total incidence of ADR(17.0%)of the women in the observation group was significant lower than that(42.2%)of the women in the control group(all P<0.05).Conclusion:Immunoglobulin combined with low molecular weight heparin for treating women with RSA can effectively improve their clinical symptoms,regulate their levels of E and P,and reduce the levels of serum MCP-1,CCL2,and CCR4,and the values of uterine hemodynamics indexes,improve their immune function,and promote pregnancy outcomes.