發(fā)布時間：2018-05-23 23:11

  本文選題：不明原因復發(fā)性流產 + 肝素　； 參考：《天津醫(yī)科大學》2014年碩士論文

【摘要】：目的：復發(fā)性流產的病因十分復雜,可能是多因素共同作用的結果,給治療增加了難度。目前國內外多研究認為不明原因復發(fā)性流產(URSA)與血栓前狀態(tài)(PTS)密切相關,凝血系統(tǒng)和纖溶系統(tǒng)的紊亂可引發(fā)反復流產。血漿高水平的纖溶酶原激活物抑制劑-1(PAI-1)是近年發(fā)現(xiàn)的血液高凝狀態(tài)發(fā)生的重要原因之一,是動靜脈栓塞性疾病的獨立危險因素�？鼓委煘橛行У姆椒�。 本課題應用肝素聯(lián)合阿司匹林治療URSA,通過監(jiān)測臨床癥狀、妊娠結局、實驗檢查以論證抗凝治療URSA的有效性及安全性。探討URSA患者血漿PAI-1及血漿組織型纖溶酶原活化因子(t-PA)水平及其與復發(fā)性流產的相關性,進一步闡述RSA的發(fā)病機制并為預防性抗凝治療提供監(jiān)測指標。探討肝素能否改變復發(fā)性流產患者血漿中PAI-1、t-PA,為肝素治療復發(fā)性流產的治療提供新的理論基礎。 方法：(1)選取2012年06月-2013年06月天津醫(yī)科大學寶坻臨床學院產科門診或住院保胎治療的復發(fā)性流產病人共75例,按患者自愿原則分為肝素治療組38例,傳統(tǒng)治療組37例,同時選取正常早期妊娠30例為對照組。三組年齡比較差異均無統(tǒng)計學意義(P0.05),兩流產史組流產次數比較無統(tǒng)計學意義(P0.05)。(2)傳統(tǒng)治療組：妊娠后給予黃體酮、絨毛膜促性腺激素加中藥治療。肝素治療組：在傳統(tǒng)治療的基礎上予低分子肝素鈣或肝素,同時口服阿司匹林治療。(3)兩治療組分別于治療前及治療后1月,正常妊娠組入組時采取孕婦靜脈血檢測PAI-1、t-PA及相關血常規(guī)、凝血功能。(4)記錄兩治療組孕婦的妊娠結局；療效判定標準為治療后妊娠大于12周者且胚胎發(fā)育良好有效；再次流產或胚胎停育為治療失��；同時隨訪新生兒有無出生缺陷。記錄兩治療組治療過程中是否有出血傾向、皮疹藥熱、胃腸道反應等藥物不良反應。(5)使用SPSS17.0軟件進行統(tǒng)計分析。計量資料用均值±標準差(x±s)表示。兩組間血小板計數、凝血試驗等指標比較采用t檢驗,多組間兩兩比對采用方差分析。P值0.05為差異有統(tǒng)計學意義。 結果： 1、兩治療組患者妊娠結局比較。肝素治療組妊娠成功率81.58%,傳統(tǒng)治療組妊娠成功率59.46%,兩組治療效果比較P0.05,有統(tǒng)計學意義。 2、兩治療組患者不良反應、血小板及凝血功能等化驗指標比較P0.05,無統(tǒng)計學意義。 3、復發(fā)性流產組治療前血漿中PAI-1與正常組比較升高,差異有統(tǒng)計學意義(P0.05), t-PA與正常組比較降低,無統(tǒng)計學意義(P0.05)。而兩復發(fā)性流產組間治療前血漿PAI-1和t-PA比較未見明顯差異(P0.05)。 4、復發(fā)性流產患者中肝素治療后血漿中PAI-1與治療前比較明顯降低,差異有統(tǒng)計學意義(P0.05),而t-PA與治療前比較增高,差異無統(tǒng)計學意義(P0.05)。 5、復發(fā)性流產患者中傳統(tǒng)方法治療后血漿PAI-1和t-PA與治療前比較差異無統(tǒng)計學意義(P0.05) 6、病理結果：復發(fā)性流產患者中妊娠失敗者胎盤或絨毛組織送病理檢查,結果顯示均存在胎盤或絨毛血管梗塞、鈣化、纖維素樣沉著等。 結論： 1、復發(fā)性流產患者存在纖溶活性下調,凝血功能增強,凝血及纖溶功能失調。 2、肝素聯(lián)合阿司匹林能改變復發(fā)性流產患者凝血狀態(tài)。 3、肝素聯(lián)合阿司匹林治療復發(fā)性流產能顯著增加治療療效,且具有安全性。
[Abstract]:Objective: the cause of recurrent abortion is very complex and may be the result of multifactor interaction, which makes it difficult for treatment. At present, many studies have found that unexplained recurrent abortion (URSA) is closely related to prethrombotic state (PTS), and the disorder of coagulation system and fibrinolytic system can cause recurrent abortion. Plasma high level plasminogen is a high level of plasminogen. Activator inhibitor -1 (PAI-1) is one of the important reasons for the occurrence of hypercoagulable state of blood in recent years. It is an independent risk factor of arteriovenous embolism. Anticoagulant therapy is an effective method.
This subject uses heparin and aspirin in the treatment of URSA by monitoring clinical symptoms, pregnancy outcome, and testing the effectiveness and safety of anticoagulant treatment of URSA. The level of plasma PAI-1 and plasma tissue type plasminogen activator (t-PA) in plasma of URSA patients and its correlation with recurrent abortion are discussed, and the pathogenesis of RSA is further elaborated. It provides a monitoring index for preventive anticoagulant therapy. Whether heparin can change PAI-1 and t-PA in the plasma of patients with recurrent abortion provides a new theoretical basis for the treatment of recurrent abortion by heparin.
Methods: (1) 75 cases of recurrent abortion in the obstetrics outpatient department of Baodi Clinical College, Baodi, Medical University Of Tianjin, 2012, 06 months, were divided into 38 cases of heparin treatment group, 37 cases in traditional treatment group and 30 cases of normal early pregnancy as control group. There were no statistical differences between three groups. Learning significance (P0.05), the number of abortion in the two abortion history group was not statistically significant (P0.05). (2) traditional treatment group: after pregnancy with progesterone, chorionic gonadotropin plus Chinese medicine. Heparin treatment group: on the basis of traditional treatment, low molecular weight heparin calcium or heparin, and oral aspirin treatment. (3) two treatment groups were treated respectively in the treatment group. PAI-1, t-PA, related blood routine and coagulation function were taken by pregnant women in the normal pregnancy group in January and January. (4) the pregnancy outcome was recorded in the two treatment group. The standard of curative effect was for the pregnant women more than 12 weeks after treatment and the embryo development was good and effective. There were no birth defects in the children. Record two treatment groups in the treatment process whether there were bleeding tendency, rash fever, gastrointestinal reaction and other adverse drug reactions. (5) SPSS17.0 software was used for statistical analysis. The mean mean standard deviation (x + s) of measurement data was expressed. Two groups of platelet counts and coagulation tests were compared with t test and 22 groups. Variance analysis using.P value of 0.05 was statistically significant.
Result錛，

本文編號：1926759