小剂量阿司匹林联合低分子肝素钙预防子痫前期的作用及对血液流变学状态和母婴结局的影响

Effect of Low-dose Aspirin Combined with Low-molecular-weight Heparin Calcium on the Prevention of Preeclampsia and Its Influence on Hemorheological Status and Maternal-infant Outcomes

目的探究小剂量阿司匹林联合低分子肝素钙预防子痫前期的作用及对血液流变学状态和母婴结局的影响。方法回顾性分析2018年6月~2021年12月在河北北方学院附属第一医院产科检查存在子痫前期危险因素的367例孕妇的药物使用数据,根据预防子痫前期药物方案分为A组(小剂量阿司匹林,n=137)、B组(低分子肝素钙,n=107)、C组(小剂量阿司匹林+低分子肝素钙,n=123)。比较用药前后的凝血功能[凝血酶原时间(prothrombin time,PT)、活化部分凝血酶原时间(activated partial thromboplastin time,APTT)、D-二聚体(D-dimer,DD)、纤维蛋白原(fibrinogen,FIB)]、血液流变学(全血黏度、血浆黏度、血细胞比容)及用药期间药物不良反应,随访至孕妇分娩记录胎盘指标[血管内皮生长因子(vascular endothelial growth factor,VEGF)、微血管密度(microvessel density,MVD)]及母婴结局。结果用药后,C组DD、FIB、全血黏度、血浆黏度、血细胞比容、早产发生率、均低于A、B组,VEGF阳性表达率、MVD、PT、APTT水平、Apgar评分高于A、B组,差异有统计学意义(P均<0.05);A、B组间凝血功能、血液流变学、胎盘指标比较及3组间子痫、剖宫产、产后出血、死胎发生率、药物不良反应发生率比较,差异无统计学意义(P均>0.05)。结论小剂量阿司匹林和低分子肝素钙均可发挥子痫前期预防作用,对凝血功能、血液流变学及胎盘指标有改善作用,联合用药预防效果更佳,且未显著增加用药风险。

Objective To investigate the efficacy of low-dose aspirin in combination with low-molecular-weight heparin calcium for the prevention of preeclampsia,as well as its impact on hemorheological status and maternal-infant outcomes.Methods A retrospective review was conducted on data from 367 pregnant women identified with risk factors for preeclampsia,who were examined in the Obstetrics Department of the First Affiliated Hospital of Hebei North University from June 2018 to December 2021.Participants were categorized into three groups based on the preventive medication regimen they received:Group A(low-dose aspirin,n=137),Group B(low-molecular-weight heparin calcium,n=107),and Group C(combination of low-dose aspirin and low-molecular-weight heparin calcium,n=123).The study compared coagulation function parameters[prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer(DD)and fibrinogen(FIB)],hemorheological measures(whole blood viscosity,plasma viscosity,hematocrit),and adverse drug reactions before and after the administration of medication.Follow-up continued until delivery to document placental indicators[vascular endothelial growth factor(VEGF),microvessel density(MVD)],and maternal-infant outcomes.Results After treatment,the DD,FIB,whole blood viscosity,plasma viscosity,hematocrit and the incidence rate of premature birth in group C were lower than those in groups A and group B while the positive expression rate of VEGF,MVD,PT,APTT and Apgar score were higher than those in group A and group B(all P<0.05).There were no statistical differences in the coagulation function,hemorheology and placental indicators between group A and group B as well as the incidence rates of eclampsia,cesarean section,postpartum hemorrhage and stillbirth and incidence rates of adverse drug reactions among the three groups(all P>0.05).Conclusion Both low-dose aspirin and low-molecular-weight heparin calcium can play a preventive role in preeclampsia,and can improve the coagulation function,hemorheology and placental indicators.The combination of the two drugs has a better preventive effect and does not significantly increase the risk of medication.