低分子肝素对复发性流产伴自身抗体阳性患者凝血与免疫的影响  

Effect of low molecular weight heparin on coagulation and immunity in patients with recurrent abortion and autoantibody positive

作　　者：廖平英 庞宁宁 周莉[1] 刘小阳 方园[1] LIAO Pingying;PANG Ningning;ZHOU Li;LIU Xiaoyang;FANG Yuan(Department of Obstetrics and Gynecology,Jiujiang Maternal and Child Health Hospital,Jiujiang,Jiangxi,332000,China)

机构地区：[1]九江市妇幼保健院妇产科,江西九江332000

出　　处：《当代医学》2024年第14期118-121,共4页Contemporary Medicine

基　　金：江西省卫生健康委科技计划(202211904)。

摘　　要：目的探讨低分子肝素钠对复发性流产(RSA)伴自身抗体阳性患者凝血及免疫的影响。方法选取2019年1月至2021年1月九江市妇幼保健院收治的80例RSA患者作为研究对象,根据早孕期自身抗体阳性筛选结果分为RSA阳性组与RSA阴性组,各40例。两组均行低分子肝素联合小剂量阿司匹林治疗,比较两组血栓前状态相关指标[D-二聚体(D-D)、抗凝血酶Ⅲ(AT-Ⅲ)、组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制剂-1(PAI-1)、蛋白S(PS)]及免疫功能相关指标[白细胞介素-4(IL-4)、白细胞介素-10(IL-10)、转化生长因子-β(TGF-β)、γ干扰素(IFN-γ)、白细胞介素-6(IL-6)]。结果治疗后,两组D-D、t-PA及PAI-1水平均低于治疗前,AT-Ⅲ、PS水平均高于治疗前,且RSA阴性组D-D、t-PA、PAI-1水平均低于RSA阳性组,AT-Ⅲ、PS水平均高于RSA阳性组,差异有统计学意义(P<0.05)。治疗后,两组IL-4、IL-10、TGF-β水平均高于治疗前,IL-6、IFN-γ水平均低于治疗前,且RSA阴性组IL-4、IL-10、TGF-β水平均高于RSA阳性组,IL-6、IFN-γ水平均低于RSA阳性组,差异有统计学意义(P<0.05)。结论低分子肝素治疗RSA伴自身抗体阳性患者效果显著,但效果与自身抗体阴性患者相比不佳。Objective To investigate the effect of low molecular weight heparin sodium on coagulation and immunity in patients with recurrent spontaneous abortion(RSA)and autoantibody positive.Methods 80 RSA patients admitted to Jiujiang Maternal and Child Health Hospital from January 2019 to January 2021 were selected as the research subjects,and they were divided into the RSA positive group and the RSA negative group according to the results of autoantibodies positive screening in early pregnancy,with 40 cases in each gourp.Both groups were treated with low molecular weight heparin combined with low dose aspirin,and the related indexes of prethrombotic state(D-dimer[D-D],antithrombinⅢ[AT-Ⅲ],tissue plasminogen activator[t-PA],plasminogen activator inhibitor-1[PAI-1],protein S[PS])and immune function(interleukin-4[IL-4],interleukin-10[IL 10],transforming growth factor-β[TGF-β],interferon-gamma[IFN-γ],interleukin-6[IL-6])were compared between the two groups.Results After treatment,the levels of D-D,t-PA and PAI-1 of the two groups were lower than those before treatment,the levels of AT-Ⅲand PS were higher than those before treatment,and the levels of D-D,t-PA and PAI-1 in the RSA negative group were lower than those in the RSA positive group,the levels of AT-Ⅲand PS were higher than those in the RSA positive group,and the differences were satistically significant(P<0.05).After treatment,the levels of IL-4,IL-10 and TGF-βof the two groups were higher than those before treatment,the levels of IL-6 and IFN-γwere lower than those before treatment,and the levels of IL-4,IL-10 and TGF-βin the RSA negative group were higher than those in the RSA positive group.and the levels of IL 6 and IFN-γwere lower than those in the RSA positive group,and the differences were statistically significant(P<0.05).Conclusion Low molecu-lar weight heparin has an excellent effect on RSA patients with autoantibody positive,but the effect is not good compared with those with autoanti-body negative.

关 键 词：低分子肝素 复发性流产 自身抗体阳性 凝血功能 免疫功能 

分 类 号：R714.21[医药卫生—妇产科学]