低分子肝素治疗复发性流产效果及患者外周血Th1/Th2各型细胞因子及子宫动脉血流阻力变化

Effect of low molecular weight heparin for treating women with recurrent spontaneous abortion and the changes of Th1/Th2 cytokines levels in peripheral blood and uterine artery blood flow resistance of these patients

目的:探讨低分子肝素治疗复发性流产(RSA)效果及对患者外周血辅助性T淋巴细胞(Th1/Th2)各型细胞因子及子宫动脉血流阻力变化。方法:选取2019年4月-2021年6月本院收治的RSA患者109例,根据治疗方法不同分为对照组(n=48,阿司匹林联合黄体酮治疗)和观察组(n=61,达肝素钠联合黄体酮治疗),产前检查正常孕妇50例为正常组。检测3组动脉收缩末其峰值/舒张末期流速值(S/D)、搏动指数(PI)、阻力指数(RI),Th1/Th2型细胞因子白介素-2(IL-2)、γ干扰素(IFN-γ)、肿瘤坏死因子(TNF-α)、IL-4、IL-10水平,观察孕30周时妊娠情况及不良反应。结果:治疗前动脉血流阻力S/D、PI、RI,观察组和对照组均高于正常组,治疗后对照组和观察组S/D、PI、RI均降低且观察组低于对照组(P<0.05)。治疗前对照组和观察组IL-2、IFN-γ、TNF-α水平均高于正常组,IL-4、IL-10水平均低于正常组(P<0.05),治疗后观察组和对照组IL-2、IFN-γ、TNF-α均降低且观察组低于对照组,观察组和对照组IL-4、IL-10水平高于治疗前且观察组高于对照组(均P<0.05)。孕30周时,正常组保胎率100.0%(50例),对照组79.2%(38例),观察组93.4%(57例),观察组高于对照组(P=0.001)。总不良反应发生观察组(22.9%)与对照组(25.0%)无差异(P>0.05)。结论:联合低分子肝素可更好地减少RSA患者子宫动脉血流阻力、维持Th1/Th2免疫平衡,维持妊娠,提高了临床疗效,安全性较好。

Objective: To evaluate the effect of low molecular weight heparin(LMWH) for treating women with recurrent spontaneous abortion(RSA), and to study the changes of Th1/Th2 cytokines levels in peripheral blood and uterine artery blood flow resistance of these patients. Methods: A total of 109 women with RSA were selected and were divided into group A(61 women with treatment of dalteparin sodium combined with progesterone) and group B(48 women with treatment of aspirin combined with progesterone) according to different treatment methods from April 2019 to June 2021. 50 normal pregnant who had been pre-pregnancy examinees were included in group C during the same period. The values of peak end-systolic/end-diastolic velocity(S/D), pulsatility index(PI), resistance index(RI), and the levels of Th1/Th2 cytokines, such as interleukin-2(IL-2), interferon gamma(IFN-γ), tumor necrosis factor(TNF-α), IL-4, and IL-10 of the women in the three groups were detected. The pregnant situation and the adverse reactions rate of the women during 30 gestational weeks in the three groups were observed. Results: Before treatment, the values of arterial blood flow resistance S/D, PI, and RI of the women in group A and group B were significantly higher than those of the women in group C. After treatment, the values of S/D, PI, and RI of the women in group B and group A had decreased significantly, and which of the women in group A was significantly lower than that of the women in group B(P<0.05). Before treatment, the levels of IL-2, IFN-γ, and TNF-α of the women in group B and group A were significantly higher than those of the women in group C, while the levels of IL-4 and IL-10 of the women in group B and group A were significantly lower than those of the women in group C(P<0.05). The levels of IL-2,IFN-γ,and TNF-αof the women in group A and in group B after treatment had decreased significantly,and the levels of IL-4and IL-10of the women in group A and in group B after treatment had increased significantly,and both of which of the women in group A were significantly higher than those of the women in group B(P<0.05).In 30 gestational weeks,the prevent miscarriages rate of the women in group C was 100.0%(50cases),that of the women in group B was 79.2%(38cases),and that of the women in group A was 93.4%(57cases),and which of the women in group A was significantly higher than that of the women in group B(P=0.001).There was no significant difference in the total adverse reactions rate(22.9% vs.25.0%)of the women between group A and group B(P<0.05).Conclusion:The LMWH combined with progesterone for treating women with RSA can better reduce their uterine artery blood flow resistance,maintain their Th1/Th2 immune balance and their pregnancy,and improve their clinical efficacy,with better safety.