摘要
目的 探究阿司匹林(LDA)联合低分子肝素(LMWH)在不明原因反复早期妊娠失败(URPL)治疗中的风险-效益。方法 选择2021年1月至2021年12月于重庆市妇幼保健院/重庆医科大学附属妇女儿童医院就诊的URPL患者(174例)为研究对象;根据治疗方法,分为A(常规治疗)、B(LDA)和C(LDA联合LMWH)组,每组58例。另选正常育龄期女性(58例)作为对照组。应用Meta分析方法分别合并A、B组以及B、C组孕妇的结果,建立多准则决策模型,评估联合治疗URPL的风险-效益。结果 与对照组相比,A、B两组孕妇治疗12周后的雌二醇(E2)、绒毛膜促性腺激素(HCG)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、收缩末期峰值与舒张末期峰值的比值(S/D)、子宫动脉阻力指数(RI)、保胎成功率均差异显著(P<0.05),C组孕妇治疗12周后APTT、S/D、RI、保胎成功率均差异显著(P<0.05)。通过计算A、B组的效益和风险值以及效益-风险总值,结果显示,B组的效益高、风险低。当效益与风险都很重要时,A和B组的效益-风险总值分别为58和69,B组100%优于A组。通过计算B、C组的效益值、风险值以及效益-风险总值,结果显示,C组的效益高、风险低。当效益与风险都很重要时,B和C组的效益-风险总值分别为64和77,C组100%优于B组。结论 对于URPL的临床治疗,LDA联合LMWH较常规治疗以及单纯LDA治疗效果更好,可显著降低妊娠期并发症以及不良妊娠结局发生概率,值得临床推广。
Objective To explore the risk benefit of aspirin(LDA)combined with low molecular weight heparin(LMWH)in the treatment of unexplained recurrent pregnancy loss(URPL).Methods URPL patients(174 cases)who visited Chongqing Maternal and Child Health Hospital,Women and Children's Hospital Affiliated to Chongqing Medical University from January 2021 to December 2021 were selected as the study subjects.According to the treatment methods,they were divided into A(routine treatment),B(LDA)and C(LDA combined with LMWH)groups,with 58 cases in each group.Another women of normal childbearing age(58 cases)were selected as the control group.Meta analysis method was used to combine the results of pregnant women in groups A,B and B,C,respectively,to establish a multi criteria decision-making model to evaluate the risk benefit of combined treatment of URPL.Results Compared with the control group,there were significant differences in echelon 2(E2),human chorionic gonadotrophin(HCG),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-dimer(D-D),peak systolic/peak diastolic(S/D),resistance index(RI),and the success rate of fetal protection between group A and group B after 12 weeks of treatment(P<0.05),and there were significant differences in APTT,S/D,RI,and the success rate of fetal protection between group C after 12 weeks of treatment(P<0.05).By calculating the benefit and risk value and the total benefit risk value of Group A and Group B,the results show that Group B has high benefit and low risk.When both benefits and risks are important,the total benefit risk values of Group A and Group B are 58 and 69 respectively,and Group B is 100%better than Group A.By calculating the benefit value,risk value and benefit risk total value of Group B and Group C,the results show that Group C has high benefit and low risk.When both benefits and risks are important,the total benefit risk values of Group B and Group C are 64 and 77 respectively,and Group C is 100%better than Group B.Conclusion For the clinical treatment of URPL,LDA combi
作者
石岩
徐冬梅
龙俊
SHI Yan;XU Dongmei;LONG Jun(Department of Gynecology,Chongqing Maternal and Child Health Hospital,Women and Children's Hospital Affiliated to Chongqing Medical University,Chongqing 401120,China)
出处
《中国优生与遗传杂志》
2023年第5期974-981,共8页
Chinese Journal of Birth Health & Heredity
基金
重庆市科卫联合医学科研项目(2021MSXM173)。
