小剂量阿司匹林联合低分子肝素对妊娠期易栓症患者子宫动脉血流、凝血功能及妊娠结局的影响

Effects of low-dose aspirin combined with low molecular weight heparin on uterine artery blood flow,coagulation function and pregnancy outcomes in patients with gestational thrombophilia

目的探讨联合使用小剂量阿司匹林和低分子肝素对妊娠期易栓症患者子宫动脉血流、凝血功能和妊娠结局的影响。方法回顾性分析2019年5月至2021年5月本院66例妊娠期易栓症孕妇的临床资料,根据治疗方式不同分为联合用药组(N=39)和低分子肝素组(N=27)。联合用药组接受小剂量阿司匹林联合低分子肝素抗凝治疗,低分子肝素组接受低分子肝素抗凝治疗;比较两组治疗8周后凝血指标包括凝血酶时间(PT)、活化部分凝血酶时间(APTT)、D-二聚体(D-D),血液流变学指标包括全血高切黏度、全血低切黏度,子宫血流动脉血流指标包括搏动指数(PI)、阻力指数(RI)、收缩期峰值流速/舒张期流速(S/D);比较两组妊娠结局以及药物不良反应情况。结果治疗后,两组PT、APTT较治疗前升高,D-D较治疗前下降,差异无统计学意义(P>0.05),且联合用药组D-D显著低于低分子肝素组,差异有统计学意义(P<0.05),治疗后两组间PT、APTT比较,差异无统计学意义(P>0.05);两组全血高切黏度、全血低切黏度较治疗前明显下降,差异无统计学意义(P>0.05),且联合用药组显著低于低分子肝素组,差异有统计学意义(P<0.05);联合用药组S/D、RI和PI较治疗前明显下降,差异无统计学意义(P>0.05),且联合用药组显著低于低分子肝素组,差异有统计学意义(P<0.05);联合用药组胎停和死胎率低于低分子肝素组,活产率高于低分子肝素组,差异有统计学意义(P<0.05),两组流产率、早产率比较差异无统计学意义(P>0.05);治疗期内,两组不良反应发生率比较差异无统计学意义(P>0.05)。结论妊娠期易栓症患者使用小剂量阿司匹林联合低分子肝素抗凝治疗,能通过有效改善血液高凝状态、降低胎盘血管阻力等机制改善血流动力学以及妊娠结局,同时不良反应未明显增加。

Objective To explore the effects of low-dose aspirin combined with low molecular weight heparin(LMWH)on uterine artery blood flow,coagulation function and pregnancy outcomes in patients with gestational thrombophilia.Methods The clinical data of 66 pregnant women with gestational thrombophilia in the hospital were retrospectively analyzed between May 2019 and May 2021.According to different treatment methods,they were divided into the combination medication group(N=39)and the LMWH group(N=27).The combination medication group was given low-dose aspirin combined with LMWH,while the LMWH group was given LMWH for anti-coagulation treatment.The coagulation indexes[thrombin time(PT),activated partial thrombin time(APTT),D-dimer(D-D)],hemorheology indexes(whole blood high-shear viscosity,whole blood low-shear viscosity)and uterine artery blood flow indexes[pulsatility index(PI),resistance index(RI),peak systolic velocity/end-diastolic velocity(S/D)]after 8 weeks of treatment,pregnancy outcomes and adverse drug reactions were compared.Results After treatment,PT and APTT increased,while D-D decreased in both groups(P>0.05).D-D in combination medication group was lower than in LMWH group(P<0.05).There was no significant difference in PT or APTT after treatment(P>0.05).After treatment,whole blood high-shear viscosity and whole blood low-shear viscosity in both groups were decreased(P>0.05),while lower in the combination medication group than in the LMWH group(P<0.05).After treatment,S/D,RI and PI in both groups were decreased(P>0.05),while lower in the combination medication group than in the LMWH group(P<0.05).The incidence of fetal arrest and stillbirth in the combination medication group was lower than in the LMWH group,while live birth rate was higher than in the LMWH group(P<0.05).There was no significant difference in the incidence of miscarriage and premature delivery(P>0.05).There was no significant difference in incidence of adverse reactions(P>0.05).Conclusion Low-dose aspirin combined with LMWH for anti-coagulation treatment can improve hemodynamics and pregnancy outcomes in patients with gestational thrombophilia by effectively improving blood hypercoagulability and reducing placental vascular resistance,without significant increase of adverse reactions.