低分子肝素对不明原因型复发性流产患者妊娠期间Th1、Th17及相关趋化因子水平的影响

Effect of low molecular weight heparin on levels of Th1,Th17 and related chemokines in patients with unexplained recurrent pregnancy loss during pregnancy

目的探讨低分子肝素(LMWH)对不明原因型复发性流产(URPL)患者妊娠期间Th1、Th17及其相关趋化因子水平的影响。方法抽取2019年6月至2021年6月漯河医专二附院妇产科收治的URPL患者110例,按照随机数字表法将其分为对照组和观察组,每组55例。研究过程中,观察组流产1例,样本丢失2例;对照组流产2例,样本丢失2例,最终完成研究例数为对照组51例,观察组52例。对照组采用黄体酮联合叶酸常规治疗,观察组在对照组治疗基础上加入LMWH治疗。比较两组细胞因子水平、不良反应发生率及妊娠并发症发生率。结果治疗后,观察组患者孕28周、孕34周的Th1相关趋化因子CXCL10、CXCL11含量高于对照组(P<0.05)。对照组不良反应发生率(9.80%,5/51)与观察组(7.69%,4/52)比较差异未见统计学意义(P>0.05)。对照组妊娠并发症发生率(3.92%,2/51)与观察组(5.77%,3/52)比较差异未见统计学意义(P>0.05)。结论LMWH治疗可能在孕晚期通过上调CXCL10、CXCL11水平进而募集更多的Th1和Th17,产生不利的免疫反应,但LMWH具有较好的用药安全性。

Objective To investigate the effect of low molecular weight heparin(LMWH)on levels of T-helper 1 cell(Th1),T-helper 17 cell(Th17)and related chemokines in patients with unexplained recurrent pregnancy loss(URPL)during pregnancy.Methods A total of 110 patients with URPL admitted to the Department of Obstetrics and Gynecology of the Second Affiliated Hospital of Luohe Medical Colloge from June 2019 to June 2021 were selected,and they were divided into control group and observation group,with 55 patients in each group.During the study,1 case miscarried,and 2 sample lost in the observation group.Two cases miscarried,and 2 sample lost in the control group.Finally,51 cases in the control group and 52 cases in the observation group completed the study.The control group was treated with progesterone combined with folic acid,while the observation group was treated with LMWH based on the treatment of the control group.The levels of cytokines,incidence of adverse reactions and incidence of pregnancy complications were compared between the two groups.Results After treatment,the contents of Th1-related chemokines CXCL10 and CXCL11 in the observation group were significantly higher than those in the control group at 28 and 34 weeks of pregnancy,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the control group(9.80%,5/51)and the observation group(7.69%,4/52),P>0.05.There was no significant difference in the incidence of pregnancy complications between the control group(3.92%,2/51)and the observation group(5.77%,3/52),P>0.05.Conclusions LMWH treatment may increase the levels of CXCL10 and CXCL11 in the third trimester of pregnancy,and then raise more Th1 and Th17,resulting in adverse immune response,but LMWH has good medication safety.