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中华妇幼临床医学杂志(电子版) ›› 2016, Vol. 12 ›› Issue (05) : 576 -582. doi: 10.3877/cma.j.issn.1673-5250.2016.05.016

所属专题: 文献

论著

低分子量肝素钙治疗早发型重度子痫前期的临床研究
任丽萍1, 陈维娜2,(), 蔡蓓珺2, 舒群2   
  1. 1. 200092 上海,同济大学医学院;200051 上海市长宁区妇幼保健院妇产科
    2. 200051 上海市长宁区妇幼保健院妇产科
  • 收稿日期:2016-02-08 修回日期:2016-09-01 出版日期:2016-10-01
  • 通信作者: 陈维娜

Clinical research of low-molecular-weight heparin calcium in treatment of early onset severe pre-eclampsia

Liping Ren1, Weina Chen2,(), Beijun Cai2, Qun Shu2   

  1. 1. Tongji University School of Medicine, Shanghai 200092, China; Department of Gynecology and Obstetrics, Shanghai Changning Maternity & Child Health Hospital, Shanghai 200051, China
    2. Department of Gynecology and Obstetrics, Shanghai Changning Maternity & Child Health Hospital, Shanghai 200051, China
  • Received:2016-02-08 Revised:2016-09-01 Published:2016-10-01
  • Corresponding author: Weina Chen
  • About author:
    Corresponding author: Chen Weina; Email:
引用本文:

任丽萍, 陈维娜, 蔡蓓珺, 舒群. 低分子量肝素钙治疗早发型重度子痫前期的临床研究[J/OL]. 中华妇幼临床医学杂志(电子版), 2016, 12(05): 576-582.

Liping Ren, Weina Chen, Beijun Cai, Qun Shu. Clinical research of low-molecular-weight heparin calcium in treatment of early onset severe pre-eclampsia[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2016, 12(05): 576-582.

目的

探讨低分子量肝素钙治疗早发型重度子痫前期(PE)的疗效及其对凝血功能,肝、肾功能的影响。

方法

选择2011年12月至2015年12月在上海市长宁区妇幼保健院住院治疗的51例早发型重度PE患者为研究对象。根据治疗方式,将其分为观察组(n=25,采用常规治疗方法联合低分子量肝素钙治疗)与对照组(n=26,采用常规治疗方法)。统计学分析两组患者治疗前及治疗第3、7、10及14天时24 h尿蛋白定量、尿量,平均动脉压(MABP)、舒张压,血小板计数、血细胞比容(HCT),凝血功能,肝、肾功能指标,以及两组剖宫产术中及术后各观察时点出血量,妊娠延长时间,新生儿结局、孕妇并发症发生率。两组患者的发病孕龄、年龄、孕次、产次等基本临床资料比较,差异均无统计学意义(P>0.05)。

结果

①治疗后观察组患者中位妊娠延长时间较对照组高,差异有统计学意义(Z=2.922,P=0.003)。②治疗第3、7天时,观察组患者24 h尿蛋白定量均较对照组低,差异均有统计学意义(Z=2.023,P=0.032;Z=2.546,P=0.021)。治疗第7、10天时,观察组患者24 h尿量均较对照组高,差异均有统计学意义(Z=2.553,P=0.011;Z=2.233,P=0.026)。治疗第3天时,观察组患者MABP较对照组低,差异有统计学差异(t=2.825,P=0.007)。治疗第3、7天时,观察组HCT均较对照组低,差异均有统计学意义(t=3.117,P=0.001;t=2.546,P=0.021)。治疗第3、7、10及14天时,观察组活化部分凝血活酶时间(APTT)均较对照组显著延长,差异均有统计学意义(P<0.05)。治疗第10、14天时,观察组纤维蛋白原(Fib)水平均较对照组低,差异均有统计学意义(t=2.208,P=0.035;t=2.238,P=0.028)。治疗第3、10天时,观察组肌酐水平均较对照组高,差异均有统计学意义(t=2.299,P=0.045;t=2.599,P=0.014)。观察组患者胎盘梗死灶发生率为16.7%(4/25),显著低于对照组的57.7%(15/26),差异有统计学意义(χ2=9.477,P=0.002)。②两组患者治疗前、后舒张压、血小板计数、凝血酶原时间(PT)、碱性磷酸酶(AP)水平、白蛋白水平,以及两组剖宫产术中、术后2及24 h出血量,新生儿出生体重、胎儿生长受限及胎盘蜕膜血管病变发生率分别比较,差异均无统计学意义(P>0.05)。

结论

采用低分子量肝素钙治疗早发型重度PE患者,可控制患者血压,降低尿蛋白水平,抑制因血管内皮受损引起的血液高凝状态,对肾功能可能有改善作用,可延长妊娠时间,不增加母婴不良妊娠结局。

Objective

To explore the clinical effects of low-molecular-weight heparin calcium in treatment of early onset severe pre-eclampsia (PE) and its influence on coagulation function and hepatorenal function.

Methods

From December 2011 to December 2015, a total of 51 cases of inpatients with early onset severe PE in Shanghai Changning Maternity & Child Health Hospital were selected as research subjects. According to their treatment methods, they were divided into observation group (n=25, treated with conventional treatment and low-molecular-weight heparin calcium) and control group (n=26, only treated with conventional treatment). The clinical index including 24 hours quantitative urinary protein, 24 hours urinary volume, mean arterial blood pressure (MABP), diastolic pressure, blood platelet counts, hematocrit (HCT), coagulation function and hepatorenal function, bleeding volume at each observation point during and after cesarean section, extended pregnancy time and incidence of complications between the two groups were analyzed by statistical methods. There were no significant differences among age, gestational age, gravidity and parity between the two groups (P>0.05).

Results

①After treatment, the media extended pregnancy time in observation group was longer than that in control group, and the difference was statistically significant (Z=2.922, P=0.003). On the 3rd and 7th day of treatment, the 24 hours quantitative urine protein in observation group both were lower than those in control group, and both the differences were statistically significant (Z=2.023, P=0.032; Z=2.546, P=0.021). On the 7th and 10th day of treatment, the 24 hours urinary volumes in observation group both were higher than those in control group, and both the differences were statistically significant (Z=2.553, P=0.011; Z=2.233, P=0.026). On the 3rd day of treatment, the MABP in observation group was lower than that in control group, and the difference was statistically significant (t=2.825, P=0.007). On the 3rd and 7th day of treatment, HCT in observation group both were lower than those in control group, and both the differences were statistically significant (t=3.117, P=0.001; t=2.546, P=0.021). On the 3rd, 7th, 10th and 14th day of treatment, the activated partial thromboplastin time (APTT) in observation group all were statistically longer than those in control group, and all the differences were statistically significant (P<0.05). On the 10th and 14th day of treatment, the levels of fibrinogen (Fib) in observation group both were lower than those in control group, and both the differences were statistically significant (t=2.208, P=0.035; t=2.238, P=0.028). On the 3rd and 10th day of treatment, the creatinine levels in observation group both were higher than those in control group, and both the differences were statistically significant (t=2.299, P=0.045; t=2.599, P=0.014). The incidence of placental infarction in observation group was 16.7% (4/25) which was obviously lower than 57.7% (15/26) in control group, and the difference was statistically significant (χ2=9.477, P=0.002). ②There were no statistical significances among the diastolic pressure, blood platelet counts, prothrombin time (PT), levels of alkaline phosphatase (AP) and albumin before and after treatment, hemorrhage volume during cesarean section, 2- and 24-hour after cesarean section, neonatal birth weight, the incidence of fetal growth restriction and placenta decidual vascular lesions between the two groups (P>0.05).

Conclusions

Low-molecular-weight heparin calcium in the treatment of early onset severe PE can control the intensive blood pressure, reduce the level of urine protein, inhibit the blood hypercoagulable state caused by the damage of vascular endothelium, may improve the renal function, and extend the pregnancy time without increasing the adverse pregnancy outcomes of mother and infant.

表1 两组患者及其分娩新生儿基本临床资料及妊娠延长时间比较[M(P25P75)]
表2 两组患者所有观察时点的24 h尿蛋白定量、尿量比较[M(P25P75)]
表3 两组患者所有观察时点的平均动脉压及舒张压比较(mmHg, ±s)
表4 两组患者所有观察时点的血小板计数、血细胞比容、凝血功能指标及剖宫产术中、术后各观察时点出血量比较(±s)
组别 例数 血小板计数(×109/L)
治疗前 治疗第3天 治疗第7天 治疗第10天 治疗第14天
观察组 25 167.2±40.7 159.4±43.3 158.8±39.9 158.2±27.6 156.8±21.3
对照组 26 131.5±33.6 121.3±18.1 139.4±19.5 131.3±23.6 155.5±33.9
检验值 ? t=1.545 t=1.952 t=1.189 t=1.526 t=0.325
P ? 0.145 0.203 0.161 0.145 0.241
组别 例数 HCT(%)
治疗前 治疗第3天 治疗第7天 治疗第10天 治疗第14天
观察组 25 35.8±2.3 35.0±1.3 35.5±2.0 36.5±2.5 36.9±3.6
对照组 26 35.1±4.3 31.4±3.1 31.7±4.2 35.2±1.2 35.8±4.6
检验值 ? t=1.481 t=3.117 t=2.546 t=0.819 t=0.401
P ? 0.145 0.001 0.021 0.302 0.612
组别 例数 PT(s)
治疗前 治疗第3天 治疗第7天 治疗第10天 治疗第14天
观察组 25 11.2±0.5 11.2±0.7 11.1±0.6 11.2±0.5 11.2±0.6
对照组 26 11.3±0.3 11.2±0.4 11.3±0.4 11.1±0.1 10.8±0.3
检验值 ? t=1.481 t=0.687 t=1.267 t=1.328 t=0.337
P ? 0.145 0.496 0.217 0.199 0.738
组别 例数 APTT(s)
治疗前 治疗第3天 治疗第7天 治疗第10天 治疗第14天
观察组 25 35.9±2.3 36.4±4.3 37.5±2.7 38.2±2.7 36.6±3.5
对照组 26 35.9±2.9 34.0±4.6 35.0±1.8 34.6±0.1 36.9±8.1
检验值 ? t=0.335 t=2.320 t=2.705 t=2.525 t=2.139
P ? 0.739 0.002 0.007 0.012 0.032
组别 例数 Fib水平(g/L)
治疗前 治疗第3天 治疗第7天 治疗第10天 治疗第14天
观察组 25 4.2± 0.6 3.7±0.9 3.7±0.4 3.6±0.8 4.0±0.5
对照组 26 6.7±10.6 4.0±0.8 4.5±0.7 4.7±0.8 5.0±0.7
检验值 ? t=0.248 t=0.083 t=1.748 t=2.208 t=2.238
P ? 0.805 0.934 0.087 0.035 0.028
组别 例数 出血量(mL)
剖宫产术中 剖宫产术后2 h 剖宫产术后24 h
观察组 25 190(100~250) 10(10~20) 230(60~310)
对照组 26 220(100~250) 20(5~30) 250(55~330)
检验值 ? Z=0.992 Z=0.083 Z=0.155
P ? 0.321 0.934 0.085
表5 两组患者所有观察时点的碱性磷酸酶、白蛋白、肌酐水平比较(±s)
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