遗传性易栓症患者产科并发症的风险因素及低分子量肝素对其治疗的影响

Risk factors for obstetric complications in patients with hereditary thrombophilia and the effect of low molecular weight heparin on its treatment

目的分析遗传性易栓症患者产科并发症的风险因素及低分子肝素(LMWH)对其治疗的影响。方法回顾性分析2002年3月至2018年3月于本中心IT诊断前妊娠未接受LMWH治疗的88例患者(250例妊娠)的临床资料。考虑自变量风险因素:年龄≥35岁、体重指数≥25 kg/m^(2)和≥30 kg/m^(2)、血栓栓塞病史、产科并发症家族史、抗磷脂抗体、高风险型遗传性易栓症,分析产科并发症与上述因素的相关性。结果从88名遗传性易栓症患者中获得250例妊娠数据。与流产相关的风险因素为年龄≥35岁和血栓栓塞病史(P<0.05);与胎儿损失相关的风险因素为高风险型遗传性易栓症(P<0.05);与胎盘介导的并发症相关的风险因素为产科并发症家族史和抗磷脂抗体(P<0.05)。LMWH早期治疗对流产和总体产科并发症具有明显的保护作用(P<0.05)。结论高龄、血栓栓塞病史、高风险型遗传性易栓症、并发症家族史和抗磷脂抗体是导致遗传性易栓症患者产科并发症的重要影响因素,LMWH早期治疗对产科并发症有明显的保护作用。

Objective To analyze the risk factors of obstetrical complications in patients with hereditary thrombophilia and the effect of low molecular weight heparin(LMWH)on its treatment.Methods The clinical data of 88 patients(250 pregnancies)who were not treated with LMWH before IT diagnosis in our center from March 2002 to March 2018 were retrospectively analyzed.The risk factors considered for independent variables were the age≥35 years old,BMI≥25 kg/m^(2) and≥30 kg/m^(2),history of thrombus embolism,family history of obstetrical complications,antiphospholipid antibody and high risk inherited thrombophilia,the correlation between these fators and the obstetric complications were analyzed.Results 250 pregnancy data were obtained from 88 patients with hereditary thrombophilia.The risk factors associated with abortion were the age≥35 years old and history of thromboembolism(P<0.05);the risk factors associated with fetal loss were high risk inherited thrombophilia(P<0.05);the risk factors associated with placenta-mediated complications were family history of obstetrical complications and antiphospholipid antibodies(P<0.05).LMWH early treatment has obvious protective effect on abortion and total obstetric complications(P<0.05).Conclusion Advanced age,history of thrombus embolism,high risk hereditary thrombus,family history of obstetrical complications and antiphospholipid antibodies are important factors leading to obstetrical complications in patients with hereditary thrombophilia,early treatment of low molecular weight heparin has obvious protective effect on obstetrical complications.