小剂量阿司匹林联合低分子肝素治疗时长对产科抗磷脂综合征妊娠结局的影响  

Effect of the treatment duration of low-dose aspirin combined with low molecular weight heparin on the pregnancy outcome of obstetric antiphospholipid syndrome

作　　者：陈玥 王敬民 李相君[1] 李晓东[1] 龙尚琴 杨晓杰 CHEN Yue;WANG Jing-min;LI Xiang-jun;LI Xiao-dong;LONG Shang-qin;YANG Xiao-jie(Department of Obstetrics and Gynecology,First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]大连医科大学附属第一院产科,辽宁大连116011

出　　处：《中国实用妇科与产科杂志》2022年第7期739-742,共4页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨小剂量阿司匹林联合低分子肝素治疗时长对产科抗磷脂综合征(obstetric antiphospholipid syndrome,OAPS)妊娠结局的影响。方法回顾性分析2017年1月至2020年6月大连医科大学附属第一医院收治的115例OAPS患者的临床资料,其中孕早期开始用药至整个妊娠期为全程用药组;≥14周开始用药或仅用阿司匹林或低分子肝素单药治疗或中途停药为部分用药组,妊娠期未使用阿司匹林及低分子肝素为未用药组。分析3组的足月及早产活产率、妊娠丢失情况、妊娠并发症及新生儿评分。结果3组活产率分别为93.5%、85.7%、50%;足月分娩率分别为79.0%、54.3%、11.1%,两两比较差异均有统计学意义(P<0.05)。3组早产率分别为14.5%、31.4%、38.9%,两两比较差异均有统计学意义(P<0.05);三组中子痫前期重度和(或)胎儿生长受限发生率分别为17.74%、28.57%、66.67%。3组新生儿5 min Apgar评分及出生体重比较差异有统计学意义(P<0.01)。未治疗组合并慢性高血压比例最高,并与其他两组比较差异均有统计学意义(P<0.05)。logistic回归显示,孕周及用药方案与活产结局相关,未用药组妊娠丢失风险增加3倍。结论小剂量阿司匹林联合低分子肝素是治疗OAPS的有效方法,妊娠期全程用药可明显改善分娩结局。对妊娠高血压疾病患者应积极筛查自身免疫性疾病相关指标。Objective To investigate the effect of the treatment duration of low-dose aspirin combined with low molecular weight heparin on pregnancy outcome of women with obstetric antiphospholipid syndrome(OAPS).Methods The clinical data of 115 patients with OAPS admitted to the First Affiliated Hospital of Dalian Medical University from January 2017 to June 2020 were retrospectively analyzed.The whole course medication group included the patients receiving medication from the beginning of early pregnancy throughout the whole pregnancy,partial medication group were those who started taking drugs at≥14 weeks,or were treated with aspirin or low molecular weight heparin alone or stopped taking drugs midway.Untreated group were those who did not use aspirin or low molecular weight heparin during pregnancy.The full-term and preterm live birth rates,pregnancy loss,pregnancy complications and neonatal scores were analyzed among the 3 groups.Results The live yields of the three groups were 93.5%,85.7%and 50%respectively.The full-term delivery rates were 79.0%,54.3%and 11.1%respectively.There was significant difference between each two groups(P<0.05).The preterm birth rates of the three groups were 14.5%,31.4%and 38.9%respectively.There was significant difference between each two groups(P<0.05).The incidence of severe preeclampsia and/or fetal growth restriction in the three groups were 17.74%,28.57%and 66.67%respectively,which had statistical differences;the 5min Apgar score and birth weight also had statistical differences among the three groups(P<0.01).The proportion of chronic hypertension in untreated group was the highest,and there was significant difference compared with the other two groups(P<0.05).Logistic regression showed that gestational weeks and medication regimen were related to live birth outcome,and the risk of pregnancy loss increased 3-fold in the untreated group.Conclusion sLow-dose aspirin combined with low molecular weight heparin is an effective method in the treatment of OAPS.The whole course treatment of

关 键 词：产科抗磷脂综合征 小剂量阿司匹林 低分子肝素 妊娠结局 

分 类 号：R714.25[医药卫生—妇产科学]