抗凝治疗对子宫动脉阻力增高的复发性流产患者疗效及早期妊娠结局的影响

Effect of anticoagulant therapy on recurrent spontaneous abortion with increased uterine artery resistance and early pregnancy outcome

目的研究子宫动脉阻力增高复发性流产(RSA)患者的凝血相关指标变化,同时探讨抗凝治疗对其子宫动脉阻力及早期妊娠结局的影响。方法将2019年1月至2020年5月就诊于瑞安市人民医院的135例子宫动脉阻力增高RSA妊娠患者作为RSA组,将同期就诊于同一医院的70例正常妊娠者作为正常妊娠组,比较两组在孕5~6周时的凝血相关指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、同型半胱氨酸(Hcy)]。将RSA组根据患者意愿分为两组,A组采用地屈孕酮片治疗,B组采用抗凝(达肝素钠针联合阿司匹林片)及地屈孕酮片治疗,比较两组在孕13周时的子宫动脉阻力情况及早期妊娠结局。结果孕5~6周时RSA组D-D水平显著高于正常妊娠组(P<0.05),但RSA组的PT、APTT、FIB、Hcy与正常妊娠组比较无显著差异。A组及B组子宫动脉血流参数在孕13周时均较孕5周时下降(P<0.05),但B组血流参数下降程度较A组显著(P<0.05),且B组妊娠成功率较A组显著升高(P<0.05)。结论妊娠早期D-D可作为RSA患者筛查与评估的参考指标,达肝素钠针联合阿司匹林抗凝治疗在改善子宫动脉血流阻力及早期妊娠结局方面有显著效果。

Objective To research the changes of coagulation-related indexes in patients with recurrent spontaneous abortion(RSA)with increased uterine artery resistance,and to explore the effects of anticoagulant therapy on uterine artery resistance and early pregnancy outcome.Methods A total of 135 cases of RSA pregnancy patients with increased uterine artery resistance admitted to Rui'an People's Hospital from January 2019 to May 2020 were collected as RSA group.At the same time,70 normal pregnant women were collected as normal pregnaney group,and the coagulation-related indexes[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-dimer(D-D),homocysteine(Hcy)]of the two groups at 5 to 6 weeks of gestation were compared.The RSA group was divided into two groups,group A was treated with dydrogesterone tablets,group B was treated with anticoagulation(dalteparin sodium needle combined with aspirin tablets)and dydrogesterone tablets.The uterine artery resistance and early pregnancy outcomes were compared between the two groups at 13 weeks of pregnancy.Results At 5 to 6 weeks of gestation,D-D level in RSA group was significantly higher than that in normal pregnancy group(P<0.05),However,PT,APTT,FIB and Hcy in RSA patients were not significantly different from those in normal pregnancy.The uterine artery flow parameters of RSA patients in group A and group B decreased at 13 weeks of gestation compared with 5 weeks of gestation(P<0.05),but the decrease of blood flow parameters of group B was more significant than that in group A(P<0.05),and the pregnancy success rate of group B was significantly higher than that in group A(P<0.05).Conclusions D-D in early pregnancy can be used as a reference index for the screening and evaluation of RSA patients.Anti-coagulation therapy of dalteparin sodium injection combined with aspirin has a significant effect on improving uterine artery blood flow resistance and early pregnancy outcome.