不明原因复发性流产患者凝血功能、血液流变学状况及低分子肝素治疗效果  

Coagulation function and hemorheology status of pregnant women with unexplained recurrent miscarriage and the therapeutic effect of the pregnant women by low molecular weight heparin

作　　者：岳蕾 宋晓晖 徐慧[1] 李玉霞 徐婉丽 YUE Lei;SONG Xiaohui;XU Hui;LI Yuxia;XU Wanli(Wuhan Children's Hospital Affliate to Tongji Medical College,Huazhong University of Science&Technology(Wuhan Maternal and Child Health Care Hospital),Wuhan,Hubei Province,430016;The Eight Hospital of Wuhan,Hubei Province)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院),430016 [2]湖北省武汉市八医院

出　　处：《中国计划生育学杂志》2022年第3期542-546,共5页Chinese Journal of Family Planning

基　　金：武汉市医学科研项目(WX19D20)。

摘　　要：目的:探讨不明原因复发性流产(URSA)患者凝血功能、血液流变学状况及低分子肝素(LMWH)治疗效果。方法:选择2019年1月-2020年6月本院收治的URSA患者96例,随机数字表法分为两组各48例,对照组给予常规保胎治疗、观察组加用LMWH治疗,检测两组妊娠前(基线期)、妊娠6、8周时凝血功能指标[D-二聚体(D-D)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶活血酶时间(APTT)、纤维蛋白原(FIB)]、血液流变学参数[高切与低切全血表观黏度、全血还原黏度、血浆黏度],并与48例健康孕妇(健康组)、比较。结果:基线期、妊娠6周及8周时,URSA患者的D-D、FIB、高切与低切全血表观黏度、全血还原黏度、血浆黏度均高于健康组,PT、TT、APTT均低于健康组(均P<0.05)。妊娠6周、8周,健康组的D-D、全血表观黏度、全血还原黏度、血浆黏度较基线期升高,D-D、FIB降低,PT、TT、APTT、全血表观黏度、全血还原黏度、血浆黏度升高,且观察组的D-D、FIB、全血表观黏度、全血还原黏度、血浆黏度均低于对照组,PT、TT、APTT均高于对照组(均P<0.05)。观察组妊娠成功率(89.6%)高于对照组(77.1%)(P<0.05)。在用药期间观察组有10.4%的患者发生LMWH相关不良反应,主要表现为注射局部疼痛、瘀斑。结论:URSA患者妊娠前及妊娠早期均存在凝血及血液流变学异常,LMWH能够改善患者的凝血功能及血液流变学状态,提高妊娠成功率,但用药期间严密监测患者凝血功能及不良反应。Objective:To investigate the coagulation function and hemorheology status of women with unexplained recurrent miscarriage(URSA),and to study the therapeutic effect of the pregnant women by low molecular weight heparin(LMWH).Methods:A total of 96 pregnant women with URSA were selected and randomly divided into group A and group B(48 cases in each group)from January 2019 to June 2020.The women in group B were given conventional fetal protection treatment,and the women in group A were given LMWH except to conventional fetal protection treatment.The values of coagulation function indexes,such as D-dimer(DD),prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),and fibrinogen(FIB),and the values of hemorheological parameters,such as high-cut and low-cut whole blood apparent viscosity,whole blood reduced viscosity,and plasma viscosity,of the patients in group A and B before pregnancy(baseline period),and during 6 and 8 gestational weeks were detected,and which also were compared with those of 48 healthy pregnant women(in group C).Results:The values of D-D,FIB,whole blood apparent viscosity,whole blood reducing viscosity,and plasma viscosity of the women in group A and group B before pregnancy,and during 6 and 8 gestational weeks were significantly higher than those of the women in group C,but the values of PT,TT and APTT of the women in group A and group B were significantly lower(all P<0.05).The values of D-D,whole blood apparent viscosity,whole blood reductive viscosity,and plasma viscosity of the women in group C during 6 and 8 gestational weeks was significantly higher than those before pregnancy,but the FIB value of the women in group C during 6 and 8 gestational weeks was significantly lower.The values of PT,TT,APTT,whole blood apparent viscosity,whole blood reductive viscosity,and plasma viscosity of the women in group A and group B during 6 and 8 gestational weeks had increased significantly,and the values of D-D,FIB,whole blood apparent viscosity,whole blood reductive viscosity,blo

关 键 词：不明原因复发性流产 血栓前状态 凝血功能 血液流变学 低分子肝素 妊娠率 不良反应 

分 类 号：R714.21[医药卫生—妇产科学]