阿司匹林联合参归养血片孕前干预对ACA阳性复发性流产患者易栓症及再次妊娠效果

Influence of aspirin combined with Shengui yangxue tablets used as pre-pregnancy intervention of patients with positive anticardiolipin antibody and recurrent spontaneous abortion on their thrombosis occurrence and subsequent pregnancy

目的:观察阿司匹林联合参归养血片孕前干预对抗心磷脂抗体(ACA)阳性复发性流产(RSA)患者易栓症的影响。方法:将2017年1月-2020年6月本院妇科门诊ACA阳性RSA患者114例随机分为对照组(n=57)与观察组(n=57),对照组给予阿司匹林治疗,观察组加用参归养血片辅助治疗,疗程3个月经周期。比较两组治疗后ACA、狼疮抗凝物质(LA)、抗β2-糖蛋白I抗体(β2-GPI)转阴情况,治疗前后检测凝血指标D-二聚体、血小板聚集率、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)和纤维蛋白原(FIB);血液流变学参数[全血高切黏度、全血低切黏度、血浆黏度];子宫动脉阻力指数(RI)、收缩期峰值流速与舒张末期血流速度比(S/D)。结果:治疗后,观察组血清ACA(86.0%)、β2-GPI(80.8%)转阴率高于对照组(63.2%、58.7%)(P<0.05),两组LA转阴率无差异(P>0.05);APTT、PT高于对照组,D-二聚体、血小板聚集率、全血高切黏度和全血低切黏度、血浆黏度均低于对照组(P<0.05),但两组TT水平无差异(P>0.05);子宫动脉的RI和S/D均低于对照组,成功妊娠率(73.7%)高于对照组(57.9%),再次妊娠流产率(7.1%)低于对照组(18.2%)(P<0.05)。结论:参归养血片辅助治疗ACA阳性RSA有利于改善患者易栓症,调节子宫血流灌注,提高再次妊娠成功率并降低再次流产风险。

Objective:To observe the influence of aspirin combined with Shengui yangxue tablets used as pre-pregnancy intervention of patients with positive anticardiolipin antibody(ACA)and recurrent spontaneous abortion(RSA)on their thrombosis occurrence.Methods:114 patients with positive ACA and RSA were selected and were randomly divided into two groups(57 cases in each group).The patients in the control group were given aspirin treatment,and the patients in the observation group were given treatment of aspirin combined with Shengui yangxue tablets.The conversion situations of ACA,lupus anticoagulant(LA),and anti-β2-glycoprotein antibody(β2-GPI)of the patients after treatment were compared between the two groups.The values of coagulation index,such as D-dimer,platelet aggregation rate,activated partial thromboplastin time(APTT),the prothrombin time(PT),thrombin time(TT),and fibrinogen(FIB),and the values of hemorheology parameters,such as whole blood high shear viscosity,whole blood low shear viscosity,and plasma viscosity,and the values of uterine artery resistance index(RI)and the ratio of peak systolic velocity to end-diastolic end diastolic velocity(S/D)of the patients in the two groups before and after treatment were detected.Results:After treatment,the ratios of serum ACA negative conversion(86.0%)andβ2-GPI(80.8%)of the patients in the observation group were significantly higher than those(63.2%and 58.7%)of the patients in the control group(P<0.05),but there was no significant difference in the ratio of LA negative conversion of the patients between the two groups(P>0.05).The values of APTT and PT of the patients in the observation group were significantly higher than those of the patients in the control group,while the D-dimer level,the platelet aggregation rate,and the values of whole blood high viscosity,whole blood low viscosity,and plasma viscosity of the patients in the observation group were significantly lower than those of the patients in the control group(P<0.05),and there was no significant difference in the TT level of the patients between the two groups(P>0.05).The uterine artery RI and S/D values of the patients in the observation group were significantly lower than those of the patients in the control group.The rate of successful pregnancy(73.7%)of the patients in the observation group was significantly higher than that(57.9%)of the patients in the control group,and the rate of the pregnancy again(7.1%)of the patients in the observation group was significantly lower than that(18.2%)of the patients in the control group(P<0.05).Conclusion:Aspirin combined with Shengui yangxue tablets used for adjuvant therapy of the patients with positive ACA and RSA is beneficial to improve their thrombosis,which can regulate uterine blood perfusion,improve the success rate of subsequent pregnancy,and can reduce the risk of re-abortion.