摘要
目的探讨血栓弹力图检测在复发性流产(RSA)治疗中的指导意义。方法选择2021年7月至2023年7月在本院生殖医学科收治的复发性流产患者80例作为观察组,随机数字表法分为常规治疗组(40例)和联合治疗组(40例),常规治疗组是在确认宫内妊娠后予以小剂量阿司匹林片治疗,服用至妊娠20周;联合治疗组在常规治疗组基础上予以低分子肝素钙注射液治疗,用至妊娠12周。对比治疗前后2组患者的凝血五项指标,血栓弹力图指标、血常规指标。同时筛选本院健康体检育龄期女性80名为对照组,并比较对照组与观察组治疗前的凝血5项指标,血栓弹力图指标,血常规指标。结果与对照组比较,在治疗前观察组(常规治疗组和联合治疗组)凝血指标中D-二聚体、纤维蛋白原(FIB)升高,活化部分凝血活酶时间(APTT)下降(FIB、APTT始终在正常参考区间范围内),血栓弹力图参数反应时间(R)值下降,最大振幅(MA)及综合凝血指数(CI)值增加,差异具有统计学意义(P<0.05),血常规各指标差异无统计学意义(P>0.05)。观察组2种治疗方法比较,在治疗前凝血5项指标,血栓弹力图,血常规差异无统计学意义(P>0.05),在治疗后2组方法中均表现为D-二聚体下降,血栓弹力图R值增加,MA及CI值下降,并且联合治疗组改善效果更为明显,差异均有统计学意义(P<0.05),2组治疗前后APTT变化差异也具有统计学意义(P<0.05),但变化并不超过参考区间。2种治疗方法均随访至妊娠28周,联合组治疗方法流产发生率7.5%(3/40),常规组流产发生率15.0%(6/40),联合治疗低于常规治疗。结论血栓弹力图检测可以更灵敏地反映RSA患者非妊娠期是否处于血栓前状态,能够更有效地指导用药,经小剂量阿司匹林联合低分子肝素治疗,RSA患者流产率下降。
Objective To This study aims to investigate the potential role of thrombelastogram(TEG)in guiding the treatment of recurrent spontaneous abortion(RSA).Methods Eighty patients with RSA admitted to the Department of Reproductive Medicine our hospital from July 2021 to July 2023 were selected as the observation group,and were randomly divided into conventional treatment group(n=40)and combined treatment group(n=40).The conventional treatment group was treated with low dose aspirin tablets after confirming intrauterine pregnancy,which was continued until 20 weeks of pregnancy.In addition,the combined treatment group also received low molecular weight heparin calcium injection starting from week 12 of pregnancy.The five items of coagulation function for evaluating improvement of coagulation,TEG parameters,and blood routine indexes before and after treatment were compared between the two groups.Meanwhile,a control group consisting of 80 women in childbearing age from our hospital was screened,and their five items of coagulation function,TEG parameters,and blood routine indexes before treatment were compared with those in the observation group.Results Before treatment initiation,both subgroups within the observation group(conventional treatment group and combined treatment group)showed increased D-dimer and FIB levels while decreased APTT levels when compared with the control group(the changes in FIB and APTT did not exceed their reference intervals).Moreover,there was a statistically significant decrease in R value for TEG parameters along with an increase in MA and CI values(P<0.05),whereas no significant differences were observed regarding blood routine indexes(P>0.05).Furthermore,prior to therapy initiation within the observation group comparing different treatments methods showed no statistically significant differences among all five items of coagulation function TEG parameters,and blood routine indexes(P>0.05).After treatment,D-D dimer decreased,the R value of TEG parameters increased along with an decreased in MA and CI values in the two groups,and the improvement effect was more obvious in the combined treatment group.The differences were statistically significant(P<0.05),and the changes of APTT before and after treatment between the two groups were also statistically significant(P<0.05),but the changes did not exceed the reference interval.The incidence of abortion was 7.5%(3/40)in the combined treatment group and 15.0%(6/40)in the conventional group,which was lower than that in the conventional treatment.Conclusion Through the analysis of TEG,it can more sensitively reflect whether RSA patients are in pre-thrombotic state during non-pregnancy,and can be more effective in guiding drug use.The abortion rate of RSA patients can be reduced by low-dose aspirin combined with low molecular weight heparin.
作者
任颖
赵蓉
何玉洁
Ren Ying;Zhao Rong;He Yujie(Department of Blood Transfusion,the First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Reproduction,the First Hospital of Shanxi Medical University,Taiyuan 030001,China)
出处
《实用医技杂志》
2024年第2期95-99,共5页
Journal of Practical Medical Techniques
基金
山西医科大学第一医院院基金项目(YY2205)。
