肝素对反复妊娠丢失伴抗磷脂抗体阳性孕妇的疗效探讨  

Study of heparin on pregnant woman with recurrent pregnant loss and positive anti-phospholipid antibody

作　　者：付锦华[1] 王占英 郎芳芳[1] 

机构地区：[1]山东潍坊市人民医院产科,261041 [2]山东昌邑市妇幼保健院

出　　处：《中华围产医学杂志》2004年第5期276-278,共3页Chinese Journal of Perinatal Medicine

摘　　要：目的　探讨肝素治疗因抗磷脂抗体所致反复性妊娠丢失及对孕妇血液中抗体的影响。　方法　前瞻性地将 4 8例反复性妊娠丢失患者 (排除遗传、感染、内分泌及子宫附件等导致流产的其它因素 ) ,狼疮抗凝抗体 (lupusanticoagulation ,LA)和 /或抗心磷脂抗体 (anticardiolipinantibody ,ACA)阳性患者 ,就诊后一经诊断为妊娠即随机分为两组 ,各 2 4例 ,分别给予肝素 (研究组 )和小剂量阿司匹林加强的松 (对照组 )治疗 ,观察两组治疗前后LA和ACA的量和妊娠结局。　结果　 ( 1)研究组 2 4例中 ,2 1例足月产 ( 87.5 0 % )、2例早产 ( 8 33% )、新生儿Apgar评分 5min≥ 8分 ;1例流产( 4 .17% ) ,活婴 2 3例 ,活产率 95 .83% ( 2 3/2 4 ) ,与对照组的 19例足月产 ( 79.17% )相比 ,差异无显著性 (P >0 .0 5 )。 ( 2 )研究组 2 4例妊娠者中 17例抗体被清除 ,清除率为 70 .83% ,与对照组 2 9.17% ( 7/2 4 )比较 ,差异有显著性 (P <0 .0 1)。　结论　肝素对抗磷脂抗体所致的反复妊娠丢失治疗效果肯定 。Objective To evaluate the effect of heparin on women with recurrent pregnant loss with positive anti phospholipid antibody and its influence on these antibodies serum level. Methods Forty eight patients with recurrent pregnancy loss were randomized to receive aspirin and prednisone (control group)or heparin (study group). Those caused by other factors such as heredity, infection, endocrine system and uterus and appendixes but with positive lupus anticoagulant (LA) or/and anticardiolipin antibodies (ACA) were excluded Pregnant outcome and the level of LA and ACA before and after medication were observed. Results In study group, 21 delivered at full term (87.50%), 2 premature births(8.33%) with Apgar scores more than 8 at 5 min, 1 abortion(4.17%). The rate of live birth was 95.83% (23/24) with no difference to that of control group (79.16%,19/24) ( P > 0.05). The rate of antibody elimination [70.83% (17/24)]was significantly higher than that of control group [29.17%(7/24 ) ( P <0.01)]. Conclusions Heparin is effective in managing recurrent pregnant loss due to positive anti phospholipid antibodies and reducing serum antibody level.

关 键 词：肝素 反复妊娠丢失 抗磷脂抗体阳性 孕妇 治疗 疗效观察 

分 类 号：R714.2[医药卫生—妇产科学]