那曲肝素钙联合阿司匹林治疗复发性流产的效果及对患者血清TSP-1、sflt-1水平影响

目的　探讨那曲肝素钙联合阿司匹林治疗复发性流产（RSA）的效果及对患者血清血小板反应蛋白-1（TSP-1）、可溶性血管内皮生长因子受体-1（sflt-1）水平的影响。方法　选取2019年1月至2020年1月佳木斯市妇幼保健院收治的RSA患者112例为观察对象，按照随机数字表法分为对照组与观察组，每组56例。对照组年龄（29.36±2.82）岁，流产次数（4.79±0.45）次，孕周（7.64±0.75）周；观察组年龄（29.29±2.80）岁，流产次数（4.77±0.43）次，孕周（7.68±0.77）周。对照组采用阿司匹林治疗，观察组加用那曲肝素钙治疗。比较两组凝血4项［凝血酶原时间（PT）、凝血酶时间（TT）、部分活化凝血酶时间（APTT）、纤维蛋白原（FIB）］与血清TSP-1、sflt-1水平及不良反应、保胎结局。计量资料进行t检验，计数资料用χ²检验。结果　治疗后，观察组PT、TT、APTT长于对照组［（12.46±1.02）s比（11.63±1.05）s、（14.40±1.17）s比（13.25±1.16）s、（29.67±2.12）s比（26.92±2.19）s］，FIB低于对照组［（3.56±0.34）g/L比（4.02±0.35）g/L］，差异均有统计学意义（均P<0.05）；治疗后，观察组血清TSP-1、sflt-1均低于对照组［分别为（0.83±0.07）μg/L比（1.17±0.09）μg/L、（7 512.06±731.65）μg/L比（9 050.79±722.10）μg/L］，差异均有统计学意义（t=33.315、11.201，均P<0.001）；观察组不良反应发生率为12.50%（7/56），与对照组的5.36%（3/56）比较，差异无统计学意义（P>0.05）；观察组保胎成功率为83.93%（47/56），高于对照组的66.07%（37/56），差异有统计学意义（χ²=4.719，P=0.030）。结论　那曲肝素钙联合阿司匹林治疗复发性流产能改善患者的凝血功能，并下调血清TSP-1、sflt-1水平，降低流产率，提高保胎成功率。

Effect of nadroparin calcium combined with aspirin in treatment of recurrent spontaneous abortion and its influence on patients' serum levels of TSP-1 and sflt-1

Objective　To investigate the effect of nadroparin calcium combined with aspirin in the treatment of recurrent spontaneous abortion (RSA) and its effect on the levels of serum thrombospondin-1 (TSP-1) and soluble fms-like tyrosine kinase-1 (sflt-1). Methods　A total of 112 patients with RSA admitted to Jiamusi Maternal and Child Health Care Hospital from January 2019 to January 2020 were selected as the observation objects, and were divided into a control group and an observation group according to the random number table method, with 56 cases in each group. The control group were (29.36±2.82) years old, had (4.79±0.45) times abortion, and their gestational age was (7.64±0.75) weeks. The observation group were (29.29±2.80) years old, had (4.77±0.43) times abortion, and their gestational age was (7.68±0.77) weeks. The control group were treated with aspirin, and the observation group with aspirin and nadroparin calcium. The four blood coagulation items prothrombin time (PT), thrombin time (TT), activated partial thromboplatin time (APTT), and fibrinogen (FIB)], serum levels of TSP-1 and sflt-1, adverse reactions, and pregnancy outcomes were compared between the two groups. The measurement data were analyzed by t test, and the enumeration data by χ² test. Results　After the treatment, the PT, TT, and APTT were longer and the FIB level was lower in the observation group than in the control group (12.46±1.02) s vs. (11.63±1.05) s, (14.40±1.17) s vs. (13.25±1.16) s, (29.67±2.12) s vs. (26.92±2.19) s, and (3.56±0.34) g/L vs. (4.02±0.35) g/L], with statistical differences between the two groups (all P<0.05). After the treatment, the serum levels of TSP-1 and sflt-1 in the observation group were lower than those in the control group (0.83±0.07) μg/L vs. (1.17±0.09) μg/L and (7 512.06±731.65) μg/L vs. (9 050.79±722.10) μg/L], with statistical differences between the two groups (t=33.315 and 11.201, both P<0.001). The incidence of adverse reactions was 12.50% (7/56) in the observation group, and was 5.36% (3/56) in the control group, with no statistical difference between the two groups (P>0.05). The success rate of miscarriage protection was 83.93% (47/56) in the observation group, and was 66.07% (37/56) in the control group, with a statistical difference between the two groups (χ²=4.719, P=0.030). Conclusion　Natroparin calcium in the treatment of recurrent abortion can improve the patients' coagulation function, reduce the serum levels of TSP-1 and sflt-1 and the abortion rate, and improve the success rate of miscarriage protection.