小剂量阿司匹林对子痫前期高危孕妇发生子痫前期的预防作用及其机制

doi:10.13481/j.1671-587x.20200124

摘要/Abstract

摘要： 目的：观察小剂量阿司匹林（LDA）在子痫前期（PE）高危孕妇中的预防作用，阐明LDA预防PE的可行性和临床价值。方法：选择孕16~22周且有PE高危因素的孕妇112例，随机分为对照组58例和观察组54例。对照组患者给予安慰剂治疗，观察组患者给予75 mg·d^-1LDA治疗，睡前服药直至分娩。观察2组患者PE发生率、发病孕周、分娩孕周、胎儿出生体质量、分娩方式和围生儿结局。根据是否发生PE，将2组患者又分别分为PE（+）组（发生PE）和PE（-）组（未发生PE）。检测各组患者凝血功能指标和血小板计数，酶联免疫吸附（ELISA）法检测2组患者胎盘组织中白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、环氧酶2（COX-2）、血栓素A2（TXA2）和P-选择素（P-selectin）水平。结果：与对照组比较，观察组患者PE发生率和早产发生率明显降低（P<0.05），分娩孕周延长（P<0.05），新生儿出生体质量增加（P<0.01），足月产率增加（P<0.01）。分别与对照组PE（+）和PE（-）患者比较，观察组中PE（-）患者凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）升高（P<0.01），PE（+）患者PT升高（P<0.01），观察组PE（+）和PE（-）患者凝血酶原活动度（PTA）、纤维蛋白原（FIB）和D-二聚体（D-D）水平降低（P<0.01）。与对照组比较，观察组患者胎盘组织中IL-6、TNF-α、COX-2，TXA2和P-selectin水平明显降低（P<0.01）。结论：孕16~22周应用LDA可有效预防高危孕妇发生PE，其机制与LDA改善PE高危孕妇的凝血功能和抑制炎症因子水平有关。

关键词: 阿司匹林, 子痫前期, 高危孕妇, 预防作用

Abstract: Objective: To observe the preventive effect of low-dose aspirin (LDA) in the preeclampsia(PE) high-risk pregnant women, and to elucidate the feasibility and clinical value of LDA in preventing PE. Methods: A total of 112 PE high-risk pregnant women with 16-22 gestational weeks were selected and randomly divided into control group(n=58) and observation group(n=54). The patients in control group were given placebo treatment, the patients in observation group were given 75 mg·d^-1 LDA before going to bed until delivery.The incidence of PE, gestational age of onset, gestational age of delivery,neonatal birth weight, delivery mode, neonatal outcomes of the patients in two groups were observed.The patients in two groups were divided in to PE(+) (with PE) group and PE(-) (without PE) group according to whether PE occured or not. The coagulation function and the platelet parameters of the patients in two groups were detected; the levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α), thromboxane A2(TXA2),P-selectin in placenta tissue of the patients in two groups were detected by ELISA method. Results: Compared with control group,the incidence of PE and the incidence of premature delivery of the patients in observation group were significantly decreased(P<0.05);the gestational age of delivery of the patients in observation group were prolonged(P<0.05), the neonatal birth weight was increased(P<0.01),and the full-term birth rate was increased(P<0.01). Compared with the PE(+) and PE(-) patients in control group, the prothrombin time(PT) and activated partial thromboplastin time(APTT) of the PE(-) patients in observation group were increased(P<0.01),and the PT of the PE(+) patients in observation group was decreased (P<0.01);the levels of prothrombin activity(PTA),fibrinogen(FIB) and D-dimer(D-D) of the PE(+) and PE(-) patients in observation group were decreased. Compared with control group,the levels of IL-6,TNF-α, COX-2, TXA2 and P-selectin in placenta tissue of the patients in observation group were decreased significantly (P<0.01). Conclusion: LDA treatment within 16-22 weeks of gestation can effectively prevent the occurrence of PE in the PE high-risk pregnant women, its mechanism is related to improving the coagulation function and inhibiting the protein expressions of inflammatory factors in the PE high-risk pregnant women.

Key words: aspirin, preeclampsia, high-risk pregnant women, preventive effect

中图分类号:

R714.244

孙红霞, 蔡娱飞, 马哲, 袁捷, 张立梅, 杨贺, 马奎丽, 沈营营. 小剂量阿司匹林对子痫前期高危孕妇发生子痫前期的预防作用及其机制[J]. 吉林大学学报(医学版), 2020, 46(01): 138-143.

SUN Hongxia, CAI Yufei, MA Ze, YUAN Jie, ZHANG Limei, YANG He, MA Kuili, SHEN Yingying. Preventive effect of low-dose aspirin on preeclampsia occured in preeclampsia high-risk pregnant women and its mechanism[J]. Journal of Jilin University(Medicine Edition), 2020, 46(01): 138-143.

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