维生素D辅助低分子肝素治疗复发性流产及对血栓前状态、抗dsDNA抗体、HMGB1、sFlt-1的影响  

Effect of Vitamin D Assisted Low Molecular Weight Heparin on Prethrombotic State,Anti-dsDNA Antibody,HMGB1 and sFlt-1 in the Treatment of Recurrent Spontaneous Abortion

作　　者：张瑞青 刘莉萍 武淑慧 ZHANG Rui-qing;LIU Li-ping;WU Shu-hui(Department of Eugenics/Infertility,Zhengzhou Hospital of Traditional Chinese Medicine,Zhengzhou 450006,China;Department of Gynecology,Zhengzhou Hospital of Traditional Chinese Medicine,Zhengzhou 450006,China;Department of Obstetrics and Gynecology,Zhengzhou Hospital of Traditional Chinese Medicine,Zhengzhou 450006,China)

机构地区：[1]郑州市中医院优生优育/不孕不育科,郑州450006 [2]郑州市中医院妇科,郑州450006 [3]郑州市中医院妇产科,郑州450006

出　　处：《中国合理用药探索》2023年第11期119-124,共6页Chinese Journal of Rational Drug Use

摘　　要：目的:探究维生素D辅助低分子肝素治疗复发性流产(RSA)及对血栓前状态、抗dsDNA抗体、高迁移率族蛋白B1(HMGB1)、可溶性FMS样酪氨酸激酶1(sFlt-1)的影响。方法:选取2020年10月~2022年10月期间于我院治疗的120例RSA患者作为研究对象,依据随机数字表法分为对照组与试验组,每组60例。两组均给予叶酸片、黄体酮胶囊等常规治疗,对照组在常规治疗的基础上加用低分子量肝素钠注射液,试验组在对照组基础上口服维生素D滴剂,两组均治疗至孕12周。观察两组抗体清除率、流产率、保胎成功率等妊娠结局情况、血栓前状态指标[蛋白C(PC)、蛋白S(PS)及抗凝血酶Ⅲ(AT-Ⅲ)]、血清抗dsDNA抗体、HMGB1、sFlt-1水平及不良反应发生情况。结果:治疗后,试验组流产率(3.33%)低于对照组(15.00%,P<0.05);试验组抗体清除率、保胎成功率均高于对照组(P<0.05);两组PC、PS及AT-Ⅲ活性均升高(P<0.05),且试验组高于对照组(P<0.05);两组血清抗dsDNA抗体、HMGB1、sFlt-1水平均降低(P<0.05),且试验组低于对照组(P<0.05);治疗期间,两组不良反应发生率比较无统计学差异(P>0.05)。结论:在常规治疗基础上给予维生素D辅助低分子肝素治疗RSA可改善患者血栓前状态,纠正母体免疫紊乱,降低血清抗dsDNA抗体、HMGB1、sFlt-1水平,维持妊娠正常进行,治疗效果理想,且安全性较高。Objective:To investigate the effect of vitamin D assisted low molecular weight heparin on the prethrombotic state,anti-dsDNA antibody,high mobility group protein B1(HMGB1)and soluble FMS-like tyrosine kinase 1(sFlt-1)in the treatment of recurrent spontaneous abortion(RSA).Methods:A total of 120 patients with RSA treated in a hospital from October 2020 to October 2022 were selected and assigned into control group and test group by random number table,with 60 patients in each group.The conventional treatment such as folic acid tablet and progesterone capsules was given in both groups,and the control group was additionally treated with the low molecular weight heparin sodium injection,whereas the test group was treated with oral vitamin D drops in addition to the treatment given in the control group.Both groups were continuously treated up to 12 weeks of pregnancy.The antibody clearance,pregnancy outcomes such as spontaneous abortion and rate of successful miscarriage prevention,prethrombotic indices[protein C(PC),protein S(PS)and antithrombinⅢ(AT-Ⅲ)],levels of serum anti-dsDNA antibody,HMGB1,sFlt-1 and adverse reactions were observed in the two groups.Results:After treatment,the rate of spontaneous abortion in the test group(3.33%)was lower than that in the control group(15.00%,P<0.05).The rates of antibody clearance and successful miscarriage prevention in the test group were higher than those in the control group(P<0.05).The activities of PC,PS and AT-Ⅲwere increased in both groups(P<0.05),and were higher in the test group as compared with the control group(P<0.05).The levels of anti-dsDNA antibody,HMGB1 and sFlt-1 in serum were decreased in both groups(P<0.05),and were lower in the test group as compared with the control group (P<0.05). During the treatment period, there was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: The vitamin D assisted low molecular weight heparin on the basis of conventional therapy in the treatment of pat

关 键 词：维生素D 低分子肝素 复发性流产 血栓前状态 抗DSDNA抗体 HMGB1 SFLT-1 

分 类 号：R714.21[医药卫生—妇产科学]