肝素联合阿司匹林治疗复发性流产疗效及外周血PAI-1和t-PA的变化

发布时间：2018-05-23 23:11

  本文选题：不明原因复发性流产 + 肝素　； 参考：《天津医科大学》2014年硕士论文

【摘要】：目的：复发性流产的病因十分复杂,可能是多因素共同作用的结果,给治疗增加了难度。目前国内外多研究认为不明原因复发性流产(URSA)与血栓前状态(PTS)密切相关,凝血系统和纤溶系统的紊乱可引发反复流产。血浆高水平的纤溶酶原激活物抑制剂-1(PAI-1)是近年发现的血液高凝状态发生的重要原因之一,是动静脉栓塞性疾病的独立危险因素。抗凝治疗为有效的方法。 本课题应用肝素联合阿司匹林治疗URSA,通过监测临床症状、妊娠结局、实验检查以论证抗凝治疗URSA的有效性及安全性。探讨URSA患者血浆PAI-1及血浆组织型纤溶酶原活化因子(t-PA)水平及其与复发性流产的相关性,进一步阐述RSA的发病机制并为预防性抗凝治疗提供监测指标。探讨肝素能否改变复发性流产患者血浆中PAI-1、t-PA,为肝素治疗复发性流产的治疗提供新的理论基础。 方法：(1)选取2012年06月-2013年06月天津医科大学宝坻临床学院产科门诊或住院保胎治疗的复发性流产病人共75例,按患者自愿原则分为肝素治疗组38例,传统治疗组37例,同时选取正常早期妊娠30例为对照组。三组年龄比较差异均无统计学意义(P0.05),两流产史组流产次数比较无统计学意义(P0.05)。(2)传统治疗组：妊娠后给予黄体酮、绒毛膜促性腺激素加中药治疗。肝素治疗组：在传统治疗的基础上予低分子肝素钙或肝素,同时口服阿司匹林治疗。(3)两治疗组分别于治疗前及治疗后1月,正常妊娠组入组时采取孕妇静脉血检测PAI-1、t-PA及相关血常规、凝血功能。(4)记录两治疗组孕妇的妊娠结局；疗效判定标准为治疗后妊娠大于12周者且胚胎发育良好有效；再次流产或胚胎停育为治疗失败；同时随访新生儿有无出生缺陷。记录两治疗组治疗过程中是否有出血倾向、皮疹药热、胃肠道反应等药物不良反应。(5)使用SPSS17.0软件进行统计分析。计量资料用均值±标准差(x±s)表示。两组间血小板计数、凝血试验等指标比较采用t检验,多组间两两比对采用方差分析。P值0.05为差异有统计学意义。 结果： 1、两治疗组患者妊娠结局比较。肝素治疗组妊娠成功率81.58%,传统治疗组妊娠成功率59.46%,两组治疗效果比较P0.05,有统计学意义。 2、两治疗组患者不良反应、血小板及凝血功能等化验指标比较P0.05,无统计学意义。 3、复发性流产组治疗前血浆中PAI-1与正常组比较升高,差异有统计学意义(P0.05), t-PA与正常组比较降低,无统计学意义(P0.05)。而两复发性流产组间治疗前血浆PAI-1和t-PA比较未见明显差异(P0.05)。 4、复发性流产患者中肝素治疗后血浆中PAI-1与治疗前比较明显降低,差异有统计学意义(P0.05),而t-PA与治疗前比较增高,差异无统计学意义(P0.05)。 5、复发性流产患者中传统方法治疗后血浆PAI-1和t-PA与治疗前比较差异无统计学意义(P0.05) 6、病理结果：复发性流产患者中妊娠失败者胎盘或绒毛组织送病理检查,结果显示均存在胎盘或绒毛血管梗塞、钙化、纤维素样沉着等。 结论： 1、复发性流产患者存在纤溶活性下调,凝血功能增强,凝血及纤溶功能失调。 2、肝素联合阿司匹林能改变复发性流产患者凝血状态。 3、肝素联合阿司匹林治疗复发性流产能显著增加治疗疗效,且具有安全性。
[Abstract]:Objective: the cause of recurrent abortion is very complex and may be the result of multifactor interaction, which makes it difficult for treatment. At present, many studies have found that unexplained recurrent abortion (URSA) is closely related to prethrombotic state (PTS), and the disorder of coagulation system and fibrinolytic system can cause recurrent abortion. Plasma high level plasminogen is a high level of plasminogen. Activator inhibitor -1 (PAI-1) is one of the important reasons for the occurrence of hypercoagulable state of blood in recent years. It is an independent risk factor of arteriovenous embolism. Anticoagulant therapy is an effective method.
This subject uses heparin and aspirin in the treatment of URSA by monitoring clinical symptoms, pregnancy outcome, and testing the effectiveness and safety of anticoagulant treatment of URSA. The level of plasma PAI-1 and plasma tissue type plasminogen activator (t-PA) in plasma of URSA patients and its correlation with recurrent abortion are discussed, and the pathogenesis of RSA is further elaborated. It provides a monitoring index for preventive anticoagulant therapy. Whether heparin can change PAI-1 and t-PA in the plasma of patients with recurrent abortion provides a new theoretical basis for the treatment of recurrent abortion by heparin.
Methods: (1) 75 cases of recurrent abortion in the obstetrics outpatient department of Baodi Clinical College, Baodi, Medical University Of Tianjin, 2012, 06 months, were divided into 38 cases of heparin treatment group, 37 cases in traditional treatment group and 30 cases of normal early pregnancy as control group. There were no statistical differences between three groups. Learning significance (P0.05), the number of abortion in the two abortion history group was not statistically significant (P0.05). (2) traditional treatment group: after pregnancy with progesterone, chorionic gonadotropin plus Chinese medicine. Heparin treatment group: on the basis of traditional treatment, low molecular weight heparin calcium or heparin, and oral aspirin treatment. (3) two treatment groups were treated respectively in the treatment group. PAI-1, t-PA, related blood routine and coagulation function were taken by pregnant women in the normal pregnancy group in January and January. (4) the pregnancy outcome was recorded in the two treatment group. The standard of curative effect was for the pregnant women more than 12 weeks after treatment and the embryo development was good and effective. There were no birth defects in the children. Record two treatment groups in the treatment process whether there were bleeding tendency, rash fever, gastrointestinal reaction and other adverse drug reactions. (5) SPSS17.0 software was used for statistical analysis. The mean mean standard deviation (x + s) of measurement data was expressed. Two groups of platelet counts and coagulation tests were compared with t test and 22 groups. Variance analysis using.P value of 0.05 was statistically significant.
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