抗凝治疗对复发性流产伴子宫动脉阻力指数增高患者血栓前状态和妊娠结局的影响

Effect of anticoagulant therapy on prethrombotic state and pregnancy outcome in patients with recurrent abortion and increased uterine artery resistance index

目的探讨抗凝治疗对复发性流产伴子宫动脉阻力指数增高患者血栓前状态和妊娠结局的影响。方法选取吉安市妇幼保健院2020年1月至12月收治的120例复发性流产伴子宫动脉阻力指数增高患者作为研究对象,按照随机数字表法分为观察组和对照组,各60例。所有患者均在阴道彩超提示宫内早早孕(孕5周内)后开始用药。对照组给予地屈孕酮片、维生素E胶囊治疗,观察组在对照组基础上加用低分子肝素钙治疗。比较两组患者治疗前后阻力指数(RI)变化、血栓前状态指标[D-二聚体(DD)、凝血酶时间(TT)、抗凝血酶Ⅲ(ATⅢ)活性]和妊娠活产率。结果观察组治疗后RI低于对照组,差异有统计学意义(P<0.05)。观察组治疗后DD低于对照组,TT和ATⅢ均高于对照组,差异有统计学意义(P<0.05)。观察组活产率高于对照组,差异有统计学意义(P<0.05)。结论抗凝治疗可有效降低复发性流产伴子宫动脉阻力指数增高患者的RI,改善血栓前状态指标和妊娠妊娠结局。

Objective To investigate the effect of anticoagulant therapy on prethrombotic state and pregnancy outcome in patients with recurrent abortion and increased uterine artery resistance index.Methods A total of 120 patients with recurrent miscarriage with increased uterine artery resistance index admitted to Ji′an Maternity and Child Health Hospital from January to December 2020 were selected as research objects.They were divided into observation group and control group according to random number table method,with 60 cases in each group,all patients began to use drugs after vaginal color Doppler ultrasound prompts early intrauterine pregnancy(within 5 weeks of pregnancy).The control group was given Dydrogesterone Tablets and Vitamin E Capsules.The observation group was treated with Low-molecular-weight Heparin Calcium on the basis of the control group.The changes of resistance index(RI),prethrombotic state indexes(D-dimer[DD],thrombin time[TT],antithrombinⅢ[ATⅢ]activity)and pregnancy activity rate were compared between the two groups before and after treatment.Results The RI score of the observation group after treatment was lower than that of the control group,and the difference was statistically significant(P<0.05).After treatment,DD in the observation group was lower than that in the control group,and TT and ATⅢwere higher than those in the control group,and the differences were statistically significant(P<0.05).The live birth rate of the observation group was higher than that of the control group,the difference was statistically significant(P<0.05).Conclusion Anticoagulant therapy can effectively reduce RI,improve prethrombotic state and pregnancy outcome in patients with recurrent abortion and increased uterine artery resistance index.