抗凝治疗方法对抗磷脂综合征患者助孕及妊娠结局的影响

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摘要目的探讨抗凝治疗方法对抗磷脂综合征患者助孕及妊娠结局的影响。方法选取2015-01至2020-12在解放军总医院第七医学中心产科建档的抗磷脂综合征患者312例作为研究对象,采用回顾性队列研究方法,分为阿司匹林组(A组,98例) 、阿司匹林联合孕后使用低分子肝素组(B组,101例) 和阿司匹林联合排卵后使用低分子肝素组(C组,113例) ,观察到产后6周,比较3组间助孕及妊娠结局的差异。结果 C组流产率(2.65%)、生化妊娠率(5.31%)明显低于B组(9.90%、14.85%)及A组(15.31%、26.53%),活产率(90.27%)明显高于B组(68.32%)及A组(51.02%),差异均有统计学意义(P均＜0.05)。C组子痫前期(3.92%)、胎儿生长受限(1.96%)、胎盘早剥(0.98%)、早产(2.94%)的发生率均明显低于B组(13.04%、8.69%、7.25%、10.14%)及A组(20.00%、22.00%、8.00%、14.00%),差异具有统计学意义(P<0.05)。C组胎儿窘迫(1.96%)及胎膜早破(3.92%)的发生率均低于B组(8.69%、13.04%)及A组(14.00%、20.00%),差异具有统计学意义(P<0.05)。结论阿司匹林联合排卵后使用低分子肝素可提高抗磷脂综合征患者的活产率,降低流产率及生化妊娠率,并可明显改善妊娠结局。

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	王晶
	东星
	步文华
	尚丽新

关键词 ：妊娠结局, 抗磷脂综合征, 阿司匹林, 低分子肝素

Abstract：Objective To explore the effect of different anticoagulant therapies on pregnancy assistance and pregnancy outcomes in patients with antiphospholipid syndrome (APS). Methods Three hundred and twelve patients with antiphospholipid syndrome filed in the Department of Obstetrics of our hospital between January 2015 and December 2020 were selected as the subjects. A retrospective cohort study was conducted.These patients were divided into the aspirin group (group A, 98 cases), aspirin combined with low molecular weight heparin group after pregnancy (group B, 101 cases) and aspirin combined with low molecular weight heparin group after ovulation (group C, 113 cases). Observation lasted until 6 weeks postpartum. The differences in pregnancy assistance and pregnancy outcomes between the three groups were studied. Results The abortion rate (2.65%) and biochemical pregnancy rate (5.31%) in group C were significantly lower than in group B (9.90%, 14.85%) and group A (15.31%, 26.53%), but the live birth rate (90.27%) was significantly higher than in group B (68.32%) and group A (51.02%) (all P<0.05). The incidence of preeclampsia (3.92%), fetal growth restriction (1.96%), placental abruption (0.98%) and preterm birth (2.94%) in group C was significantly lower than in group B (13.04%, 8.69%, 7.25%, 10.14%) and group A (20.00%, 22.00%, 8.00%, 14.00%) (P<0.05). The incidence of fetal distress (1.96%) and premature rupture of membranes (3.92%) in group C was significantly lower than in group B (8.69%, 13.04%) and group A (14.00%, 20.00%) (P<0.05). Conclusions Aspirin combined with low molecular weight heparin after ovulation can improve the live birth rate of patients with antiphospholipid syndrome, reduce the abortion rate and biochemical pregnancy rate, and significantly improve pregnancy outcome.

Key words： pregnancy outcome antiphospholipid syndrome aspirin low molecular weight heparin

收稿日期: 2021-11-06

ZTFLH:

R714

作者简介: 王晶,博士,副主任医师。

引用本文:

王晶, 东星, 步文华, 尚丽新. 抗凝治疗方法对抗磷脂综合征患者助孕及妊娠结局的影响[J]. 武警医学, 2022, 33(3): 226-230. WANG Jing, DONG Xing, BU Wenhua, SHANG Lixin. Effect of different anticoagulant therapies on pregnancy assistance and pregnancy outcomes in patients with antiphospholipid syndrome. Med. J. Chin. Peop. Armed Poli. Forc., 2022, 33(3): 226-230.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2022/V33/I3/226

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