遗传性血栓形成倾向类型及低分子量肝素治疗对既往有不良结局女性妊娠并发症的影响
The Impact of Inherited Thrombophilia Types and Low Molecular Weight Heparin Treatment on Pregnancy Complications in Women with Previous Adverse Outcome.
作者信息
Aracic Nada, Roje Damir, Jakus Ivana Alujevic, Bakotin Marinela, Stefanovic Vedran
机构信息
Department of Obstetrics and Gynecology, University Hospital Split, Croatia.
Polyclinic Cito, Split, Croatia.
出版信息
Yonsei Med J. 2016 Sep;57(5):1230-5. doi: 10.3349/ymj.2016.57.5.1230.
PURPOSE
To assess the distribution of births and spontaneous abortions, first-trimester abortion (FTA) and mid-trimester abortion (MTA), in untreated (n=128) and low molecular weight heparin (LMWH) treated pregnancies (n=50) of the same women with inherited thrombophilias and adverse pregnancy outcome (APO) in previous pregnancies. We particularly investigated the impact of LMWH on reducing the pregnancy complications in two thrombophilia types, "Conventional" and "Novel".
MATERIALS AND METHODS
50 women with inherited thrombophilia (26 Conventional and 24 Novel) and APO in previous pregnancies were included in the study. Conventional group included factor V Leiden (FVL), prothrombin G20210A (PT) mutations and antithrombin (AT), protein S (PS), and protein C (PC) deficiency, while the Novel group included methylentetrahydrofolate-reductase (MTHFR), plasminogen activator inhibitor-1 (PAI-1), and angiotensin converting enzyme (ACE) polymorphism. APO was defined as one of the following: preterm birth (PTB), fetal growth restriction (FGR), preeclampsia (PE), intrauterine fetal death (IUFD), placental abruption (PA) and deep venous thrombosis (DVT).
RESULTS
There was no difference in distribution of births and spontaneous abortions between Conventional and Novel thrombophilia in untreated pregnancies (χ²=2.7; p=0.100) and LMWH treated pregnancies (χ²=0.442; p=0.506). In untreaed pregnancies thrombophilia type did not have any impact on the frequency of FTA and MTA (χ²=0.14; p=0.711). In birth-ended pregnancies LMWH treatement reduced the incidence of IUFD (p=0.011) in Conventional and FGR, IUFD, and PTB in Novel thrombophilia group.
CONCLUSION
The equal impact of two thrombophilia types on the pregnancy outcomes and a more favorable effect of LMWH therapy on pregnancy complications in Novel thrombophilia group point the need for Novel thrombophilias screening and the future studies on this issue should be recommended.
目的
评估患有遗传性易栓症且既往有不良妊娠结局（APO）的同一组女性未经治疗的妊娠（n = 128）和接受低分子量肝素（LMWH）治疗的妊娠（n = 50）中分娩和自然流产、孕早期流产（FTA）和孕中期流产（MTA）的分布情况。我们特别研究了LMWH对降低两种易栓症类型“传统型”和“新型”妊娠并发症的影响。
材料与方法
本研究纳入了50名患有遗传性易栓症（26例传统型和24例新型）且既往有APO的女性。传统组包括因子V莱顿（FVL）、凝血酶原G20210A（PT）突变以及抗凝血酶（AT）、蛋白S（PS）和蛋白C（PC）缺乏，而新型组包括亚甲基四氢叶酸还原酶（MTHFR）、纤溶酶原激活物抑制剂-1（PAI-1）和血管紧张素转换酶（ACE）多态性。APO定义为以下情况之一：早产（PTB）、胎儿生长受限（FGR）、先兆子痫（PE）、宫内胎儿死亡（IUFD）、胎盘早剥（PA）和深静脉血栓形成（DVT）。
结果
在未经治疗的妊娠中，传统型和新型易栓症之间的分娩和自然流产分布无差异（χ² = 2.7；p = 0.100），在接受LMWH治疗的妊娠中也无差异（χ² = 0.442；p = 0.506）。在未经治疗的妊娠中，易栓症类型对FTA和MTA的发生率没有任何影响（χ² = 0.14；p = 0.711）。在分娩结束的妊娠中，LMWH治疗降低了传统型易栓症组中IUFD的发生率（p = 0.011）以及新型易栓症组中FGR、IUFD和PTB的发生率。
结论
两种易栓症类型对妊娠结局的影响相同，且LMWH治疗对新型易栓症组的妊娠并发症有更有利的影响，这表明需要对新型易栓症进行筛查，并且建议对此问题进行进一步研究。
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