阿司匹林联合炔雌醇环丙孕酮对多囊卵巢综合征合并复发性流产患者免疫活性物质、抗心磷脂抗体水平的影响

Effects of aspirin combined with ethinyl estradiol and cyproterone on the levels of immune active substances and anticardiolipin antibodies in patients with PCOS complicated with RSA

目的 探讨阿司匹林联合炔雌醇环丙孕酮治疗多囊卵巢综合征(PCOS)合并复发性流产(RSA)患者的效果。方法 选取2019年1月至2020年9月成都市西部战区空军医院120例PCOS合并RSA患者作为研究对象,采用区组随机分组法分为观察组(n=60)、对照组(n=60)。对照组给予炔雌醇环丙孕酮治疗,观察组在对照组基础上联合阿司匹林治疗。比较两组活产率、血栓前状态指标[蛋白S(PS)、蛋白C(PC)、D-二聚体(D-D)]、免疫活性物质[γ-干扰素(IFN-γ)、白介素(IL)-4、转化生长因子-β(TGF-β)]、抗心磷脂抗体(ACA)转阴率、滋养细胞侵袭(CXCL16)及凋亡(bax、p53)基因表达量、不良反应。结果 观察组活产率88.33%(53/60)高于对照组的73.33%(44/60)(P<0.05);妊娠3个月两组PS、PC、IL-4、TGF-β水平较确认妊娠时明显提高,D-D、IFN-γ水平较确认妊娠时明显降低,且观察组提高或降低幅度大于对照组(P<0.05);分娩后观察组CXCL16基因表达量高于对照组,bax、p53基因表达量低于对照组(P<0.05);两组ACA转阴率、不良反应发生率比较,差异无统计学意义(P>0.05)。结论 阿司匹林治疗PCOS合并RSA患者具有良好效果,可纠正血栓前状态及免疫紊乱,降低ACA对滋养细胞功能的影响,改善妊娠结局,安全可靠。

Objective To investigate the effect of aspirin combined with ethinyl estradiol and cyproterone in the treatment of polycystic ovary syndrome(PCOS) patients with recurrent spontaneous abortion(RSA).Methods 120 patients with PCOS and RSA in Air Force Hospital of Chengdu Western Theater from January 2019 to September 2020 were selected as research subjects, and were divided into observation group(n=60) and control group(n=60) by block random grouping. The control group was treated with ethinyl estradiol and cyproterone and the observation group was treated with aspirin on the basis of the control group. The live birth rate, prethrombotic state indicators [protein S(PS), protein C(PC), detection of D-dimer(DD)], and immune active substances [ γ-interferon(IFN-γ), interleukin(IL)-4, transforming growth factor-β(TGF-β)], anticardiolipin antibodies(ACA) negative rate, trophoblast invasion(CXCL16) and apoptosis(bax, p53) gene expression and adverse reactions were compared between the two groups. Results The live birth rate of 88.33%(53/60) in the observation group was higher than that of 73.33%(44/60) in the control group(P<0.05). At 3 months of pregnancy, the levels of PS, PC, IL-4 and TGF-β in the two groups were significantly higher than when the pregnancy was confirmed, and the levels of D-D, and IFN-γ were significantly lower than when the pregnancy was confirmed, and the increase or decrease in the observation group was greater than those in the control group(P<0.05). After delivery, the expression levels of CXCL16 genes in the observation group were higher than those in the control group, and the gene expressions of bax, and p53 were lower than those in the control group(P<0.05). There was no significant difference in the negative rate of ACA and the incidence of adverse reactions between the two groups(P>0.05). Conclusions Aspirin has a good effect in the treatment of PCOS complicated with RSA. It can correct the prothrombotic state, regulate immune balance, reduce the effect of ACA on trophoblast function, and improve pregnancy outcomes. It is safe and reliable.