Dahlman T, Sjöberg H E, Hellgren M, Bucht E
Department of Obstetrics and Gynecology, Karolinska Hospital, Stockholm, Sweden.
Br J Obstet Gynaecol. 1992 May;99(5):412-6. doi: 10.1111/j.1471-0528.1992.tb13760.x.
To investigate the effect of subcutaneous heparin treatment on calcium homeostasis in pregnancy.
A longitudinal case-control observational study.
Department of Obstetrics and Gynaecology, Karolinska Hospital, Stockholm, Sweden.
36 pregnant women with previously verified thromboembolic complications and 23 healthy pregnant control women similar in age, parity, weight, and smoking habit.
Thromboprophylaxis during pregnancy and 6 weeks post partum was given with subcutaneous heparin twice daily to the 36 women with a history of thromboembolic complications, 16 received an average dose of 24,500 IU/day and 20 a mean dose of 17,300 IU/day. Venous blood and urine samples were obtained every 4 weeks.
Serum concentrations of total calcium, ionized calcium, calcitonin and urinary calcium.
Women on high-dose heparin treatment showed significantly higher concentrations of total and ionized calcium and of calcitonin in serum and significantly lower concentrations of calcium in urine than did 23 normal pregnant controls. The differences were most pronounced in the third trimester. The results obtained in the low-dose heparin group were between those in the high-dose and the control groups. At 8 weeks postpartum there were no significant differences between the heparin-treated women and the controls. No significant differences were found during pregnancy in haematocrit, liver or renal function, serum levels of albumin, phosphate, magnesium, alkaline phosphatase, parathyroid hormone or urinary cyclic AMP.
Heparin treatment during pregnancy results in changes in calcium homeostasis and a dose-dependent response is suggested.
探讨皮下注射肝素治疗对妊娠期钙稳态的影响。
纵向病例对照观察性研究。
瑞典斯德哥尔摩卡罗林斯卡医院妇产科。
36例既往确诊有血栓栓塞并发症的孕妇和23例年龄、产次、体重及吸烟习惯相似的健康孕妇作为对照。
对36例有血栓栓塞并发症史的孕妇在孕期及产后6周给予皮下注射肝素，每日2次，16例接受平均剂量24500IU/天，20例接受平均剂量17300IU/天。每4周采集静脉血和尿样。
血清总钙、离子钙、降钙素浓度及尿钙。
高剂量肝素治疗组孕妇血清总钙、离子钙和降钙素浓度显著高于23例正常孕妇对照组，尿钙浓度显著低于对照组。这些差异在妊娠晚期最为明显。低剂量肝素组的结果介于高剂量组和对照组之间。产后8周，肝素治疗组与对照组之间无显著差异。孕期血细胞比容、肝肾功能、血清白蛋白、磷酸盐、镁、碱性磷酸酶、甲状旁腺激素水平或尿环磷酸腺苷均无显著差异。
孕期肝素治疗可导致钙稳态改变，提示存在剂量依赖性反应。
