低分子肝素在血栓前状态复发性自然流产患者中的临床应用

目的探讨低分子肝素治疗存在血栓前状态的复发性自然流产（RSA）患者的效果。方法回顾性分析2004~2007年在本院就诊的RSA患者203例,经系统的流产病因学检查,存在血栓前状态,排除应用低分子肝素禁忌证,于常规安胎治疗补充黄体酮、叶酸、维生素E的基础上,联合低分子肝素治疗。追踪妊娠结局,记录用药不良反应。结果 RSA孕妇中低分子肝素治疗前后,ACA阳性率、纤溶异常发生率分别为26.6%、56.7%和3.0%、25.1%,差异有统计学意义（P〈0.05）。低分子肝素治疗RSA后,足月活产率为81.4%,早产活产率为9.0%,流产率仅为9.6%。4例在孕期用药过程中出现少量阴道出血,1例患者出现少量牙龈出血,没有孕妇因为阴道出血事件停药。3例孕妇用药后出现肝酶升高,但程度均较轻,最高AST为156 U。无皮疹、过敏、腹泻、恶心、呕吐、头痛等不良反应。结论低分子肝素可以显著改善血栓前状态指标,包括ACA、纤溶及aβ2GP1。低分子肝素可以有效治疗RSA,改善妊娠结局,提高RSA妇女妊娠成功率。低分子肝素在妊娠期应用不良反应少,做好监测,可于孕期安全应用。

Clinical application of low molecular weight heparin in patients with recurrent spontaneous abortion and prethrombotic state

Objective To investigate the effect of low molecular weight heparin（LMWH）in the treatment of patients with recurrent spontaneous abortion（RSA）and prethrombotic state. Methods The data of 203 patients with RSA in our hospital from 2004 to 2007 were retrospectively analysed.The system examination was used in all patients with prethrombotic state,without contraindications of low molecular heparin.LMWH treatment on the basis of regular therapy like progesterone,folic acid and vitamin E were applied in all patients.Pregnancy outcomes were tracked and drug adverse reactions were recorded. Results Before and after treatment of LMWH,the ACA positive rate was 26.6% and 3.0% respectively,incidence rate of fibrinolytic abnormality was 56.7% and 25.1% respectively,with statistical difference（P〈0.05）.After treatment of LMWH,full-term live-birth rate was 81.4%,the premature live-birth rate was 9.0%,the abortion rate was only 9.6%.4 cases appeared a little vaginal bleeding in the process of drug using,1 case with bleeding gums,not interrupt for these reasons.3 cases with mild elevated liver enzymes（highest AST=156 U）.No rash,allergies,diarrhea,nausea,vomiting,headache and other adverse reactions. Conclusion LMWH can significantly improve indicators of prethrombotic state including ACA,fibrinolytic and aβ2GP1.LMWH can effectively treatment of RSA,improve the pregnancy outcome of RSA patients,improve the success rate of pregnancy in women with RSA.LMWH has little adverse reactions during pregnancy,do a good job monitoring,can be safely applied in pregnancy.