抗磷脂综合征合并妊娠不同干预时机及干预方法抗早产效果研究  

Effect of different intervention time and intervention method for preventing preterm birth in APS with pregnancy

作　　者：宋文惠[1,2] 杨孜[1] 郭宏霞[1] 王海玲[1] 

机构地区：[1]北京大学第三医院妇产科,北京100191 [2]石家庄市第四医院

出　　处：《中国实用妇科与产科杂志》2016年第10期973-978,共6页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的分析不同干预时机及干预方法在抗磷脂综合征(APS)合并妊娠者存在先兆早产或宫颈功能受到影响病例抗早产的效果。方法分析2006—2014年北京大学第三医院收治的127例原发性抗磷脂综合征合并单胎妊娠患者的临床资料,依据抗APS干预时机分为未干预、孕前干预、<孕14周干预及≥孕14周干预的4组,对其中59例存在先兆早产征象或宫颈功能受影响者将抗早产方法分为单纯抑制宫缩(A组)、抗APS+抑制宫缩(B组)以及抗APS+抑制宫缩+宫颈环扎术(C组)3种。分析早产风险因素以及不同干预时机下不同抗早产干预方法的孕周终止情况。结果早产发生率35.4%。59例有先兆早产征象或宫颈功能受影响,但早产风险因素比较差异无统计学意义(P>0.05)。平均分娩孕周在B组和C组明显大于A组(P<0.001)。C组平均分娩孕周大于B组(P=0.028)。抗APS联合抗早产干预组平均分娩孕周明显大于无抗APS的单纯抑制宫缩A组(P<0.001)。孕前干预与孕<14周干预与APS先兆早产中34周之后和37周之后分娩呈正相关。结论 APS存在早产风险,孕前或孕14周前开始干预并联合抗早产治疗可以明显延长先兆早产病例的妊娠时间,增加34周后分娩率和足月产率。Objective To evaluate the effect of different intervention time and methods on threatened preterm labor in antiphospholipid Syndrome（APS） with pregnancy.Methods One hundred and twenty-seven singleton pregnancies with APS admitted to Peking University Third Hospital from 2006 to 2014 were included in this study. According to anti-APS intervention time they were divided into four groups： non-intervention group, pre-pregnancy intervention group, intervention-before-14 gestation-week and after-14-gestation-week group. Also, the different anti-preterm birth methods were used, tocolytic agent alone（A）, anti-APS combined with tocolysis（B）, anti-APS with tocolysis and cervical cerclage（C）,in 59 out of 127 patients with threatened premature signs or cervical function weakness. The risk factors of preterm birth and the termination time of pregnancy in different intervention situations by different methods were analyzed.Results The incidence of preterm birth was 35.4%. There are 59 cases with signs of threatened premature labor or cervical function weakness, but the risk factors for preterm birth were not statistically different（P〉0.05）. Mean gestational age at delivery in B group and C group was significantly greater than that in A group（P〈0.001）, C greater than B（P=0.028）. The average gestational age at delivery in anti-APS plus anti-preterm intervention group was significantly higher than in group A（without anti-APS）（P〈0.001）. Intervention before pregnancy and at less than 14 gestation-week was positively related to delivery after 34 and 37 weeks.Conclusion APS may cause preterm birth. Beginning of the intervention before pregnancy or before 14 gestation-week and combined with anti-premature treatment can significantly prolong the threatened premature delivery beyond 34 weeks and 37 weeks of gestation in APS with pregnancy.

关 键 词：抗磷脂综合征 早产 干预 宫颈环扎术 

分 类 号：R714.25[医药卫生—妇产科学]