低分子肝素在人类辅助生殖技术获得妊娠后发生复发性流产患者中的临床研究
发布时间：2018-06-20 04:06
本文选题：低分子肝素钠 + 人类辅助生殖技术 ； 参考：《医学研究生学报》2017年04期
【摘要】：目的目前针对低分子肝素(LMWH)在人类辅助生殖技术(ART)获得妊娠后发生复发性流产(RSA)患者中的临床病例研究较少。文中旨在探讨LMWH在ART获得妊娠后发生RSA妇女中的临床应用研究。方法选择2010年1月至2016年2月于广东医科大学附属医院生殖医学中心进行ART治疗获得妊娠后发生RSA的患者126例。根据接受ART助孕治疗的病因不同,其中子宫输卵管造影提示至少有一侧输卵管为通畅的患者,接受宫腔内人工授精(IUI)助孕治疗;而有输卵管疾病体外受精-胚胎移植(IVF-ET)治疗。将同意采用LMWH治疗的60例患者按不同治疗方式分为LMWH+IUI组(接受IUI治疗)、LMWH+IVF-ET组(接受IVF-ET治疗),每组30例。将不同意采用LMWH治疗的66例患者分为IUI组(n=32)、IVF-ET组(n=34)。比较4组患者接受ART的妊娠成功率、抱婴率,再次发生RSA的妊娠时间、妊娠并发症的发病率等。同时观察LMWH使用过程中不良反应的发生情况。结果 LMWH+IUI组再次发生RSA的妊娠时间较IUI组显著增加[(82.67±9.10)d vs(48.17±8.68)d,P0.05]。LMWH+IVF-ET组妊娠成功率、抱婴率较IVF-ET组显著升高[66.67%vs35.29%;85.00%vs 50.00%,P0.05],2组再次流产的发生率、再次发生RSA的妊娠时间、妊娠期高血压疾病发生率差异亦有统计学意义(P0.05)。LMWH+IUI组、LMWH+IVF-ET组孕4周血浆D二聚体(D2D)数值[(0.65±0.07)、(0.62±0.06)mg/L]低于IUI组、IVF-ET组[(0.76±0.12)、(0.77±0.06)mg/L],LMWH+IUI组孕6周D2D值低于IUI组、IVF-ET组,LMWH+IVF-ET组低于IVF-ET组(P0.05)。4组患者的血浆D2D数值组内比较均随着孕周的增加而增加(P0.05)。LMWH+IUI组、IUI组和LMWH+IVF-ET组孕4周凝血酶原时间(PT)含量[(12.53±0.38)、(12.38±0.65)、(12.47±0.58)s]较孕前[(12.33±0.52)、(12.30±0.68)、(12.22±0.64)s]、孕6周[(12.13±0.62)、(12.05±0.60)、(12.03±0.54)s]明显增高(P0.05)。LMWH+IUI组、LMWH+IVF-ET组使用LMWH的60例患者中11例出现脐周注射部位的皮下小面积瘀青,发生率为18.33%(11/60)。仅2例患者出现皮下注射部位轻度疼痛不适感,发生率为3.33%(2/60)。结论 ART获得妊娠后发生RSA女性采用小剂量LMWH治疗安全有效。
[Abstract]:Objective to study the clinical cases of low molecular weight heparin (LMWHH) in patients with recurrent abortion (RSAs) after pregnancy with human assisted reproductive technology (ART). The purpose of this study was to investigate the clinical application of LMWH in RSA women after art pregnancy. Methods 126 patients with RSA were selected from January 2010 to February 2016 in the Center of Reproductive Medicine, affiliated Hospital of Guangdong Medical University. According to the etiology of art assisted pregnancy therapy, hysterosalpingography indicated that at least one of the patients with unobstructed fallopian tube was treated with intrauterine artificial insemination IUI (IVF-ETT) and IVF-ETT with in vitro fertilization and embryo transfer of fallopian tube disease. 60 patients agreed to LMWH were divided into LMWH IUI group (IUI group) and LMWH IVF-ET group (30 cases in each group). 66 patients who did not agree to LMWH were divided into IUI group (n = 32) and IVF-ET group (n = 34). The pregnancy success rate, the infantile rate, the pregnancy time of RSA and the incidence of pregnancy complications were compared among the four groups. At the same time, the occurrence of adverse reactions during the use of LMWH was observed. Results the pregnancy time of vs(48.17 in LMWH IUI group was significantly longer than that in IUI group [82.67 卤9.10d vs(48.17 卤8.68dP]. The pregnancy success rate and infantile rate in LMWH IVF-ET group were significantly higher than those in IVF-ET group [66.67vs35.2955.00 vs 50.00P0.05]. There was also a significant difference in the incidence of hypertensive disorder complicating pregnancy (P0.05, LMWH IUI, LMWH IVF-ET, LMWH IVF-ET, 4 weeks gestational D _ 2D) [0.65 卤0.07 ~ 0.62 卤0.06 mg / L] lower than that of IUI IVF-ET [0.76 卤0.12 mgL] LMWH IUI at 6 weeks of gestation D2D value was lower than that in IVF-ET group, LH IVF-ET group was lower than IVF-ET group, P0.05ng-1 group was lower than IVF-ET group, and the D2D value in LMWH IUI group was lower than that in IVF-ET group (0.76 卤0.12 mgg / L). The value of D2D in LMWH IVF-ET group was lower than that in IVF-ET group and IVF-ET group was lower than that in IVF-ET group (0.76 卤0.12 mg / L). 鐨勮娴咲2D鏁板，
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