低分子肝素治疗反复妊娠失败合并抗磷脂抗体阳性患者的临床效果  

Clinical Effect of Low Molecular Weight Heparin in the Treatment of Repeated Biochemical Pregnancy with APS

作　　者：沈玮[1] 付雪梅[1] 孙雪榕 SHEN Wei;FU Xuemei;SUN Xuerong(Jilin Province Maternity and Child Health Hospital(Jilin Province Obstetrics Quality Control Center)Changchun 130000,China)

机构地区：[1]吉林省妇幼保健院(吉林省产科质量控制中心),吉林长春130000

出　　处：《中国医药指南》2020年第36期24-25,28,共3页Guide of China Medicine

基　　金：省级部门预算科学研究项目(20190406)。

摘　　要：目的探讨低分子肝素治疗反复妊娠失败合并抗磷脂抗体(APL)阳性患者的临床效果。方法回顾性分析2016年3月至2020年3月我院收治的经纳入与排除标准筛查后纳入研究的334例反复妊娠失败且合并APS阳性的复发性流产患者的临床资料,依据患者治疗方式的不同将患者分为对照组(采用阿司匹林联合孕后低分子肝素,168例)和观察组(采用阿司匹林联合排卵后应用低分子肝素,166例)。比较两组的临床效果。结果观察组的活产率为71.08%(118/166),流产率为1.81%(3/166),生化妊娠率为12.65%(21/166),对照组活产率为53.57%(90/168),流产率为8.93%(15/168),生化妊娠率为22.62%(38/168),组间差异均有统计学意义(P<0.05);观察组异位妊娠率为15.66%(26/166),对照组异位妊娠率为15.66%(26/168),差异无统计学意义(P>0.05)。Logistic回归多因素分析显示,孕妇年龄、治疗方案是影响妊娠结局的危险因素(P<0.05);调整后年龄依然为患者妊娠结局的独立危险因素(P<0.05)。结论阿司匹林与低分子肝素联合使用可显著提高妊娠失败合并APS阳性患者的活产率,低分子肝素尽早应用(在孕前排卵后)的临床疗效显著优于孕后应用。Objective To investigate the clinical therapeutic effect of low molecular weight heparin(LMWH)in patients with repeated biochemical pregnancy with positive anti-phospholipid antibody(APS).Methods A retrospective analysis of the clinical data of 334 recurrent miscarriage patients with repeated pregnancy failures and positive antiphospholipid syndrome(APS)who were included in the study after screening by inclusion and exclusion criteria admitted to our hospital from March 2016 to March 2020.According to the different treatment methods of the patients,the patients were divided into a control group(168 cases with aspirin combined with low molecular weight heparin after pregnancy)and an observation group(166 cases with aspirin combined with low molecular weight heparin after ovulation).Compare the clinical effects of the two groups.Results The live birth rate of the observation group was 71.08%(118/166),higher than that of the control group(53.57%)(90/168),the abortion rate was 1.81%(3/166),the biochemical pregnancy rate was 12.65%(21/166),significantly lower than that of the control group(8.93%)(15/168),and the biochemical pregnancy rate was 22.62%(38/168).The rate of ectopic pregnancy in the observation group was 15.66%(26/166),while that in the control group was 15.66%(26/168)without significant difference(P>0.05).Logistic regression multivariate analysis showed that age and treatment plan were risk factors affecting pregnancy outcome(P<0.05).After adjustment,age was still an independent risk factor for pregnancy outcome(P<0.05).Conclusion The combination of aspirin and LMWH significantly increased the live birth rate in patients with positive antiphospholipid antibody and repeated biochemical pregnancy.The clinical efficacy of LMWH before pregnancy(after ovulation)was significantly better than that after pregnancy.

关 键 词：反复妊娠失败 低分子肝素 抗磷脂抗体 阿司匹林 活产率 

分 类 号：R714.2[医药卫生—妇产科学]