目的:探讨小剂量阿司匹林(LDA)联合维生素D预防治疗高危子痫前期(PE)效果及对孕妇凝血指标、血栓前状态的影响.方法:选取2019年7月—2023年12月本院收治的PE高危孕妇135例,根据不同治疗分为对照组(n=45)、维生素D组(n=45)和联合组(n=45).比较3组PE发生率、凝血指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和D-二聚体(D-D)]、血栓前状态[凝血酶抗凝酶复合物(TAT)、纤溶酶-抗纤溶酶复合物(PIC)、血栓调节蛋白(TM)、组织型纤溶酶原激活抑制复合物(t-PAIC)]、子宫动脉血流动力学指标[阻力指数(RI)、搏动指数(PI)]、妊娠结局.结果:治疗后,联合组的PE发生率(11.1％)低于维生素D组(31.1％)和对照组(33.3％),APTT(30.34±2.00s)、PT(12.45±2.63s)均高于维生素 D 组(23.05±2.56s、9.46±2.07s)和对照组(22.98±3.18s、8.83±1.89s),FIB(3.24±1.03 g/L)、D-D(1.34±0.35 mg/L)低于维生素 D 组(4.57±1.47 g/L、2.53±0.42 mg/L)和对照组(5.25±1.36 g/L、3.38±0.60 mg/L),TAT(9.81±1.89 ng/ml)、PIC(1.35±0.46 μg/ml)均低于维生素 D组(13.42±2.16 ng/ml、1.66±0.58 μg/ml)和对照组(14.15±2.30 ng/ml、1.72±0.53 μg/ml),RI、PI 均低于维生素 D组和对照组,剖宫产率(33.3％)和低体重儿发生率(2.3％)低于维生素D组(55.6％、15.6％)和对照组(62.2％、17.8％)(P＜0.05).结论:采用LDA联合维生素D治疗PE高危孕妇可显著改善凝血功能、血栓前状态以及子宫动脉血流动力学,进而有效预防PE的发生并改善母婴结局.
Effect of the low-dose aspirin combined with vitamin D for treating pregnant women with high-risk pre-eclampsia and its influence on the coagulation indexes and prethrombotic state
Objective:To explore the effect of low-dose aspirin(LDA)combined with vitamin D for treating pregnant women with high-risk pre-eclampsia(PE),and to study its influence on the coagulation indexes and prethrombotic state of the women.Methods:A total of 135 pregnant women with high-risk PE were selected and were divided into group A(45 women with the treatment of LDA combined with vitamin D),group B(45 women with the treatment of vitamin D)and group C(45 women without treatment)according to the different treatment methods between July 2019 and De-cember 2023.The incidence of PE,the values of the coagulation indexes,such as prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB)and D-dimer(D-D),the prethrombotic state evaluated by the values of thrombin antithrombin complex(TAT),plasminase-antiplasmin complex(PIC),thrombomodulin(TM)and tissue plasminogen activator-plasminogen activator inhibitor-1 complex(t-PAIC),the values of hemodynamic indexes of uterine artery,such as resistance index(RI)and pulsation index(PI),and the pregnancy outcomes of the women were compared among the three groups.The incidence of PE(11.1％)of the women after treatment in group A was significantly lower than that of the women in group B(31.1％)or in group C(33.3％).The values of APTT(30.34±2.00s)and PT(12.45±2.63s)of the women in group A after treatment were significantly higher than those of the women in group B(23.05±2.56s and 9.46±2.07s)or in group C(22.98±3.18s and 12.45±2.63s).The levels of FIB(3.24±1.03 g/L)and D-D(1.34±0.35 mg/L)of the women in group A were significantly lower than those of the women in group B(4.57±1.47 g/L and 2.53±0.42 mg/L)or in group C(5.25±1.36 g/L and 3.38±0.60 mg/L).The levels of TAT(9.81±1.89 ng/ml)and PIC(1.35±0.46μg/ml)of the women in group A were significantly lower than those of the women in group B(13.42±2.16 ng/ml and 1.66±0.58μg/ml)or in group C(14.15±2.30 ng/ml and 1.72±0.53μg/ml).The RI and PI values of the women in group A were significantly lower than those of the women in group B or in group C.The cesarean rate(33.3％)of the women and the incidence of the neonatal low birth weight(2.3％)in group A were significantly lower than those(55.6％and 15.6％)in group B or those(62.2％and 17.8％)in group C(P＜0.05).Conclusion:The LDA combined with vitamin D for treating the pregnant women with high-risk PE can significantly improve their coagulation function,prethrombotic state and uterine artery hemodynamics,and thus can effectively prevent the occurrence of PE of the women and improve the maternal and neonatal outcomes.
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