羟氯喹联合阿司匹林及低分子肝素治疗APS型复发性流产的临床疗效观察

Clinical efficacy of hydroxychloroquine combined with aspirin and low molecular weight heparin in the treatment of recurrent spontaneous abortion of APS type

目的:观察免疫抑制剂羟氯喹联合阿司匹林及低分子肝素在治疗抗磷脂综合征(APS)患者复发性流产(RSA)的临床疗效。方法:收集2022年1—12月就诊于广西壮族自治区玉林市妇幼保健院RSA门诊的APS型复发流产患者共65例,采用随机数字表法将患者分为治疗组和对照组。对照组30例常规予阿司匹林联合低分子肝素,治疗组35例在对照组治疗基础上加用羟氯喹。对比两组患者治疗前后的血清性激素水平[血清人绒毛膜促性腺激素(β-HCG)、孕酮(P)、雌二醇(E2)]、凝血功能[腺二磷(ADP)、D-二聚体]、子宫动脉指标[搏动指数(PI)、阻力指数(RI)]、血清抗心磷脂抗体(aCL)、抗-β2糖蛋白I抗体(anti-β2GPI Ab)、狼疮抗凝物(LAC)、治疗效果及不良反应的发生情况。结果:在妊娠12周后,治疗组患者血清E2、P和β-HCG水平较对照组升高(P<0.05);治疗组ADP、D-二聚体、子宫动脉PI和RI较对照组下降(P<0.05);治疗组患者aCL、anti-β2GPI Ab及LAC的转阴率高于对照组;治疗组治愈26例,好转8例,总有效率为97.14%;对照组治愈13例,好转11例,总有效率80.00%(P<0.05);治疗组的不良反应发生率较对照组显著降低(P<0.05)。结论:APS型RSA患者在低分子肝素联合阿司匹林治疗的基础上加用羟氯喹可以更有效的减少患者流产的发生率,值得进一步在临床推广应用。

Objective:To observe the clinical efficacy of the immunosuppressant hydroxychloroquine combined with aspirin and low molecular weight heparin in the treatment of recurrent spontaneous abortion(RSA)in patients with antiphospholipid syndrome(APS).Methods:A total of 65 patients with APS-associated RSA admitted to RSA Clinic of Yulin Maternal and Child Health Hospital,Guangxi Zhuang Autonomous Region from January 2022 to December 2022 were collected,and the patients were divided into treatment and control groups using the random number table method.30 patients in the control group were given aspirin combined with low molecular weight heparin routinely,while 35 patients in the treatment group were given hydroxychloroquine in addition to the treatment used in the control group.The serum sex hormone levels[serum human chorionic gonadotropin(β-HCG),progesterone(P),estradiolo(E2)],coagulation function[adenosine diphosphate(ADP),D-dimer],uterine artery indexes[pulsatility index(PI)、resistance index(RI)],serum anticardiolipin antibodies(aCL),anti-β2 glycoprotein I antibodies(anti-β2GPI Ab),lupus anticoagulant(LAC),treatment outcomes,and the occurrence of adverse reactions of the patients were compared before and after treatment in the two groups.Results:After 12 weeks of gestation,serum E2,P andβ-HCG levels increased in the treatment group compared with the control group(P<0.05);ADP,D-dimer,uterine artery PI and RI decreased in the treatment group compared with the control group;aCL,anti-β2GPI Ab and LAC conversion rates were higher in the treatment group than in the control group;26 cases were cured and 8 cases improved in the treatment group,with a total effective rate of 97.14%;13 cases were cured and 11 cases improved in the control group,with a total effective rate of 80.00%(P<0.05);the occurrence of adverse reactions in the treatment group was significantly lower than that in the control group(P<0.05).Conclusion:The addition of hydroxychloroquine to the treatment of patients with APS-associated RSA on the basis of low molecular weight heparin combined with aspirin can more effectively reduce the occurrence rate of abortion in patients,which is worthy of further clinical promotion and application.