低分子肝素对妊娠早期复发性流产患者子宫动脉血流影响的自身对照前瞻性研究  

A self-controlled prospective study on the effect of low molecular weight heparin on uterine artery blood flow in patients with recurrent spontaneous abortion in early pregnancy

作　　者：李媛媛[1,2,3] 陈国庆 郑欣[1] 杨云 陈小斌 侯悦[1,2,3] 乔宠 Li Yuanyuan;Chen Guoqing;Zheng Xin(Department of Obstetrics and Gynecology,Shengjing Hospital,China Medical University,Shenyang 110004;Key Laboratory of Maternal-Fetal Medicine of Liaoning Province,Shenyang 110004;Key Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province,Shenyang 110004)

机构地区：[1]中国医科大学附属盛京医院妇产科,沈阳110004 [2]辽宁省母胎医学重点实验室,沈阳110004 [3]辽宁省高校妇产科重点实验室,沈阳110004

出　　处：《现代妇产科进展》2019年第10期740-744,共5页Progress in Obstetrics and Gynecology

基　　金：国家重点研发计划资助项目(No:2016YFC1000404);国家自然基金面上项目(No:81771610);国家自然科学基金面上项目(No:81370735);盛京自由研究者基金(No:201706);辽宁省特聘教授(No:2017);辽宁省科学技术计划(No:201602601)

摘　　要：目的:研究低分子肝素(LMWH)对复发性流产(RSA)患者妊娠早期子宫动脉血流的影响,以及PI值、RI值和S/D比值对LMWH的敏感性。方法:选取2016年1月至2017年12月在中国医科大学附属盛京医院门诊就诊的妊娠早期子宫动脉血流异常、皮下注射LMWH 8000IU/d的RSA患者255例。根据用药时长分为A组(2周)、B组(3周)、C组(4周)和D组(6周)。比较分析用药前后子宫动脉血流PI值、RI值、S/D比值和切迹的变化情况,通过绘制ROC曲线对各指标进行敏感度分析。结果:A组治疗前后的子宫动脉血流PI值、RI值、S/D比值无明显差异(P>0.05),B、C、D组治疗前后有显著差异(P<0.05)。治疗前,4组的子宫动脉血流PI值、RI值、S/D比值比较,差异无统计学意义(P>0.05),随着治疗时间的增加,各项指标数值逐渐降低,PI值在3~4周稳定,RI值在4周左右稳定,S/D比值在4周时达到最低值,而到6周时又升高到3周水平。治疗后4组子宫动脉舒张期血流切迹均有部分转阴,治疗4周前后有明显差异(P<0.05)。子宫动脉血流S/D比值对LMWH治疗的敏感度明显高于PI值和RI值,两侧数值之和的敏感度高于右侧和左侧。结论:对于早期妊娠的RSA患者,LMWH皮下注射8000IU/d,持续4周以上,可有效改善异常子宫动脉血流,子宫动脉血流双侧S/D比值之和对LMWH的敏感度更高。Objective:To study the effects of different doses of low molecular weight heparin(LMWH)on uterine artery blood flow in patients with recurrent spontaneous abortion(RSA)in early pregnancy and the sensitivity of PI,RI and S/D ratio to LMWH.Methods:From Jan.2016 to Dec.2017,255 patients with abnormal uterine artery blood flow in the early pregnancy who were treated in Shengjing Hospital Affiliated to China Medical University were selected,subcutaneously injected LMWH 8000IU/d.According to the length of medication,they were divided into group A(2 weeks),group B(3 weeks),group C(4 weeks)and group D(6 weeks).The changes of PI value,RI value,S/D ratio and notch of uterine artery blood flow before and after medication were compared and analyzed.The sensitivity of each index was analyzed by ROC curve.Results:There were no significant differences in PI,RI and S/D ratio of uterine artery blood flow in group A before and after treatment(P>0.05),but there were significant differences in group B,C and D before and after treatment(P<0.05).The PI value,RI value and S/D ratio of uterine artery blood flow had no significant difference between the four groups before treatment(P>0.05).With the increase of treatment time,the values of each index gradually decreased,PI value was stable in 3~4 weeks,RI value was stable in about 4 weeks,S/D ratio reached the lowest value at 4 weeks,and increased to 3 weeks at 6 weeks.After treatment,the diastolic blood flow notches of uterine artery in group A,B,C and D were partially negative,and there was significant difference before and after 4 weeks of treatment(P<0.05).The sensitivity of S/D ratio of uterine artery blood flow to LMWH treatment was significantly higher than that of PI and RI.The sensitivity of sum of two values was higher than that of right and left.Conclusions:For RSA patients with early pregnancy,LMWH can effectively improve abnormal uterine artery blood flow by subcutaneous injection of 8000IU/d for more than 4 weeks.The sum of S/D ratio of bilateral uterine artery blood flow is

关 键 词：子宫动脉血流 低分子肝素 复发性流产 

分 类 号：R71[医药卫生—妇产科学]