不明原因复发性流产患者凝血功能、血液流变学状况及低分子肝素治疗效果

Coagulation function and hemorheology status of pregnant women with unexplained recurrent miscarriage and the therapeutic effect of the pregnant women by low molecular weight heparin

目的:探讨不明原因复发性流产(URSA)患者凝血功能、血液流变学状况及低分子肝素(LMWH)治疗效果。方法:选择2019年1月-2020年6月本院收治的URSA患者96例,随机数字表法分为两组各48例,对照组给予常规保胎治疗、观察组加用LMWH治疗,检测两组妊娠前(基线期)、妊娠6、8周时凝血功能指标[D-二聚体(D-D)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶活血酶时间(APTT)、纤维蛋白原(FIB)]、血液流变学参数[高切与低切全血表观黏度、全血还原黏度、血浆黏度],并与48例健康孕妇(健康组)、比较。结果:基线期、妊娠6周及8周时,URSA患者的D-D、FIB、高切与低切全血表观黏度、全血还原黏度、血浆黏度均高于健康组,PT、TT、APTT均低于健康组(均P<0.05)。妊娠6周、8周,健康组的D-D、全血表观黏度、全血还原黏度、血浆黏度较基线期升高,D-D、FIB降低,PT、TT、APTT、全血表观黏度、全血还原黏度、血浆黏度升高,且观察组的D-D、FIB、全血表观黏度、全血还原黏度、血浆黏度均低于对照组,PT、TT、APTT均高于对照组(均P<0.05)。观察组妊娠成功率(89.6%)高于对照组(77.1%)(P<0.05)。在用药期间观察组有10.4%的患者发生LMWH相关不良反应,主要表现为注射局部疼痛、瘀斑。结论:URSA患者妊娠前及妊娠早期均存在凝血及血液流变学异常,LMWH能够改善患者的凝血功能及血液流变学状态,提高妊娠成功率,但用药期间严密监测患者凝血功能及不良反应。

Objective:To investigate the coagulation function and hemorheology status of women with unexplained recurrent miscarriage(URSA),and to study the therapeutic effect of the pregnant women by low molecular weight heparin(LMWH).Methods:A total of 96 pregnant women with URSA were selected and randomly divided into group A and group B(48 cases in each group)from January 2019 to June 2020.The women in group B were given conventional fetal protection treatment,and the women in group A were given LMWH except to conventional fetal protection treatment.The values of coagulation function indexes,such as D-dimer(DD),prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),and fibrinogen(FIB),and the values of hemorheological parameters,such as high-cut and low-cut whole blood apparent viscosity,whole blood reduced viscosity,and plasma viscosity,of the patients in group A and B before pregnancy(baseline period),and during 6 and 8 gestational weeks were detected,and which also were compared with those of 48 healthy pregnant women(in group C).Results:The values of D-D,FIB,whole blood apparent viscosity,whole blood reducing viscosity,and plasma viscosity of the women in group A and group B before pregnancy,and during 6 and 8 gestational weeks were significantly higher than those of the women in group C,but the values of PT,TT and APTT of the women in group A and group B were significantly lower(all P<0.05).The values of D-D,whole blood apparent viscosity,whole blood reductive viscosity,and plasma viscosity of the women in group C during 6 and 8 gestational weeks was significantly higher than those before pregnancy,but the FIB value of the women in group C during 6 and 8 gestational weeks was significantly lower.The values of PT,TT,APTT,whole blood apparent viscosity,whole blood reductive viscosity,and plasma viscosity of the women in group A and group B during 6 and 8 gestational weeks had increased significantly,and the values of D-D,FIB,whole blood apparent viscosity,whole blood reductive viscosity,blood plasma viscosity of the women in group A were significantly lower than those of the women in group B,but the values of PT,TT and APTT of the women in group A were significantly higher than those of the women in group B(all P<0.05).The success rate of pregnancy(89.6%)of the women in group A was significantly higher than that(77.1%)of the women in group B(P<0.05).LMWH related adverse reactions had occurred in 10.4%of the women in group A during treatment,mainly included local pain and ecchymosis after LMWH injection.Conclusion:Coagulation and hemorheology of the pregnant women are obviously abnormal before pregnancy and during the first trimester of pregnancy.LMWH can improve the coagulation function and hemorheological status of these women,and can increase their pregnancy success rate.The coagulation function and adverse reactions of the women should be closely monitored during treatment.