叶酸联合低分子肝素和小剂量阿司匹林治疗复发性流产的临床研究

目的探讨叶酸片联合低分子肝素钙注射液和小剂量阿司匹林肠溶片治疗复发性流产的临床疗效。方法选取2016年1月—2016年8月绵阳中心医院收治的复发性流产患者94例为研究对象,按照数表法将患者随机分为对照组和治疗组,每组各47例。对照组皮下注射低分子肝素钙注射液,5 000 IU/次,1次/d;且口服阿司匹林肠溶片,75 mg/次,1次/d。治疗组在对照组基础上口服叶酸片,0.4 mg/次,1次/d。所有患者均于确定妊娠后开始治疗,并持续至临产或发生流产、早产。观察两组的临床疗效,比较两组的激素水平、凝血指标、叶酸和同型半胱氨酸(HCY)的情况。结果治疗后,对照组、治疗组的活产率分别为85.11%、93.62%,两组活产率比较差异无统计学意义。治疗后,两组人绒毛膜促性腺激素(HCG)、孕酮(P)、雌二醇(E2)水平均显著升高,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标明显高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组血浆纤溶酶原激活物抑制剂-1(PAI-1)水平明显降低,治疗前后比较差异有统计学意义(P0.05);且治疗组PAI-1水平明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组HCY水平明显下降,而叶酸水平明显升高,治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论叶酸片联合低分子肝素钙注射液和小剂量阿司匹林肠溶片治疗复发性流产具有较好的临床疗效,可改善激素水平,降低PAI-1和HCY水平,具有一定的临床推广应用价值。

Clinical study on folic acid combined with low molecular weight heparin and small dose aspirin in treatment of recurrent spontaneous abortion

Objective To investigate the clinical efficacy of Folic Acid Tablets combined with Low-molecular-weight Heparin Calcium Injection and small dose Aspirin Enteric-coated Tablets in treatment of recurrent spontaneous abortion. Methods Patients (94 cases) with recurrent spontaneous abortion in Mianyang Central Hospital from January 2016 to August 2016 were randomly divided into control and treatment groups, and each group had 47 cases. Patients in the control group were subcutaneous injection administered with Low-molecular-weight Heparin Calcium Injection, 5 000 IU/time, once daily. And Patients in the control group were also po administered with Aspirin Enteric-coated Tablets, 75 mg/time, once daily. Patients in the treatment group were po administered with Folic Acid Tablets on the basis of the control group, 0.4 mg/time, once daily. Patients in two groups were treated after pregnancy until delivery, miscarriage, and premature delivery. After treatment, the clinical efficacies were evaluated, and hormone levels, coagulation indexes, folic acid, and HCY in two groups were compared. Results After treatment, live birth rates in the control and treatment groups were 85.11% and 93.62%, respectively, and there was no difference between two groups. After treatment, the levels of HCG, P, and E₂ in two groups were significantly increased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly higher than those in the control group, with significant difference between two groups (P<0.05). After treatment, the levels of PAI-1 in the treatment group were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the levels of PAI-1 in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). After treatment, the levels of HCY in two groups were significantly decreased, but the levels of folic acid in two groups were significantly increased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). Conclusion Folic Acid Tablets combined with Low-molecular-weight Heparin Calcium Injection and small dose Aspirin Enteric-coated Tablets has clinical curative effect in treatment of recurrent spontaneous abortion, can improve hormone levels, decrease the levels of PAI-1 and HCY, which has a certain clinical application value.