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目的探讨肝素治疗对复发性流产(recurrent spontaneous abortion,RSA)患者凝血功能、并发症及妊娠结局的影响。方法选取2014年1月至2016年1月在禹城市人民医院治疗的RSA患者100例,将患者分为观察组和对照组各50例,其中对照组予黄体酮、人绒毛膜促性腺激素治疗,观察组在对照组的基础上给予肝素治疗,比较两组治疗前后纤维蛋白原(fibrinogen,FIB)、部分凝血酶原时间(activated partial thromboplastin time,APTT)、血浆组织型纤溶酶原活化因子(tissue-type plasminogen activator,t-PA)及纤溶酶原激活物抑制剂-1(plasminogen activator inhibitor-1,PAI-1)水平变化、并发症发生情况和妊娠结局。结果治疗前两组APTT、FIB、PAI-1和t-PA比较差异无统计学意义(P>0.05);治疗后,两组APTT无显著变化(P>0.05);观察组FIB和PAI-1显著降低(P<0.05),t-PA显著增加(P<0.05);对照组FIB和PAI-1无显著变化(P>0.05),t-PA显著降低(P<0.05);治疗后观察组FIB和PAI-1低于对照组,t-PA高于对照组,差异均有统计学意义(P<0.05);观察组活产率(88.00%)明显高于对照组(68.00%)(P<0.05);观察组的血小板减少、瘀斑和总并发症发生率(4.0%、4.0%、22.0%)均低于对照组(16.0%、18.0%、46.0%)(P<0.05)。结论肝素治疗对RSA有较好的疗效,能改善患者凝血状态。
Objective To investigate the effect of heparin on coagulation function, complications and pregnancy outcome in patients with recurrent spontaneous abortion (RSA). Methods A total of 100 RSA patients were treated in Yucheng People’s Hospital from January 2014 to January 2016. The patients were divided into observation group (50 cases) and control group (50 cases). The control group received progesterone and human chorionic gonadotropin . The observation group was treated with heparin on the basis of the control group. The changes of fibrinogen (FIB), activated partial thromboplastin time (APTT), plasma tissue plasminogen activator (tissue-type plasminogen activator, t-PA) and plasminogen activator inhibitor-1 (PAI-1) levels in patients with complications and pregnancy outcomes. Results There was no significant difference in APTT, FIB, PAI-1 and t-PA between the two groups before treatment (P> 0.05). After treatment, there was no significant change in APTT between the two groups (P> 0.05) (P <0.05), and the t-PA significantly increased (P <0.05). There was no significant change in FIB and PAI-1 in control group (P> 0.05) FIB and PAI-1 were lower than the control group, t-PA was higher than the control group, the difference was statistically significant (P <0.05); the live birth rate (88.00% <0.05). The incidence of thrombocytopenia, ecchymosis and total complication in the observation group (4.0%, 4.0%, 22.0%) were lower than those in the control group (16.0%, 18.0%, 46.0%, P 0.05). Conclusion Heparin treatment has a good effect on RSA, can improve the coagulation status of patients.