【作者】 李萍；

【导师】 朱付凡；

【作者基本信息】 中南大学 ， 妇产科， 2007， 硕士

【摘要】 目的：比较低分子肝素与强的松和阿司匹林治疗APS的疗效及副作用，探讨低分子肝素是否能替代强的松和阿司匹林治疗APS。方法：将ACA阳性患者80例(已孕40例，未孕40例)随机分为研究组及对照组，每组为40例。研究组予以低分子肝素(克塞)，对照组予以强的松与阿司匹林治疗，观察治疗后两组ACA转阴率，对血液流变学、骨代谢及妊娠结局的影响。结果：(1)研究组治疗1疗程、2疗程、3疗程ACA转阴数分别为5例、25例、32例，ACA转阴率分别为12.5％、62.5％和80％，对照组ACA转阴数分别为8例、32例、36例，转阴率分别为20％、80％、90％，随治疗时间延长，两组转阴率均增加，各疗程间转阴率差异有统计学意义(p＜0.05)。研究组与对照组治疗1疗程、2疗程、3疗程ACA转阴率，差异均无统计学意义(p＞0.05)。(2)研究组血浆黏度治疗前、1疗程、2疗程后分别为1.84±0.42、1.49±0.16、1.41±0.13，两两比较，差异均有统计学意义(p＜0.05)；对照组治疗前、1疗程、2疗程后分别为1.87±0.33、1.62±0.30、1.50±0.20，两两比较，差异均有统计学意义(p＜0.05)。研究组治疗1疗程、2疗程后血浆黏度均比对照组下降幅度大，差异均有统计学意义(p＜0.05)。(3)研究组血钙浓度治疗前、1疗程、2疗程后分别为2.49±0.18mmol／l、2.47±0.27mmol／l、2.50±0.26mmol／l，两两比较，差异均无统计学意义(p＞0.05)；对照组治疗前、1疗程、2疗程后分别为2.51±0.26mmol／l、2.48±0.30mmol／l、2.64±0.17mmol／l，两两比较，治疗前和1疗程与2疗程比较，均有显著差异(p＜0.05)。研究组治疗2疗程后血钙浓度均比对照组上升幅度小，差异有统计学意义(p＜0.05)。(4)研究组TRAP浓度治疗前、1疗程、2疗程后分别为4.35±0.53u／l、4.60±0.74u／l 4.55±0.56u／l，两两比较，差异均无统计学意义(p＞0.05)；对照组治疗前、1疗程、2疗程后分别为4.28±0.70u／l、5.16±0.59u／l、6.52+0.51u／l，两两比较，差异均有统计学意义(p＜0.05)。研究组治疗1疗程、2疗程后TRAP浓度均比对照组上升幅度小，差异均有统计学意义(p＜0.05)。(5)治疗后研究组与对照组妊娠成功率为分别50％和70％，两者相比，差异无统计学意义(p＞0.05)。结论：1、低分子肝素治疗APS，其ACA转阴率、妊娠结局与强的松和阿司匹林相当。2、低分子肝素治疗APS降低血浆黏度优于强的松和阿司匹林。3、低分子肝素治疗APS对骨代谢影响比强的松和阿司匹林小。4、TRAP检测可作为早期诊断骨质疏松的指标。更多还原

【Abstract】 Objects: To compare the therapeutic effect of low molecular heparinwith prednisone and aspirin in antiphospholipid syndrome and observethese influence of bone metabolism、hemorheology and pregnancyoutcome during the therapy.Metheods: A prospective observational study included 40patients(20 pregnancy patients, 20 unpregnancy patients) withanticardiolipin antibody in the study group who received low-molecularheparin. The control group of 40 patients(20 pregnancy patients, 20unpregnancy patients)received prednisone and aspirin. We comparedthese groups according to the pregnancy outcomes、the negative rate ofanticardiolipin antibody(ACA)and the influence of bone metabolism、hemorheology and pregnancy outcome during the therapy, using standardstatistical tests.Results: 1.The number of people with negative anticardiolipinantibody were 5、25 and 32 in the study group,the Clearance rate ofanticardiolipin antibody after one course of treatment、two courses oftreatment、two courses of treatment in the study group were 12.5%、62.5% and 80% and the number of people with negative anticardiolipinantibody were 8、32 and 36 and the Clearance rate of anticardiolipinantibody after one course of treatment、two courses of treatment、twocourses of treatment in the control group were 20%、80%、90%,with theprolonged treatment the Clearance rate of anticardiolipin antibody raisedup,there was significant difference (p<0.05). There was no significantdifference in the Clearance rate of anticardiolipin antibody after onecourse of treatment、two courses of treatment、two courses of treatmentbetween the study group and control group (p>0.05).2. The plasma viscosity of study group were 1.84±0.42、1.49±0.16and 1.41±0.13 before the treatment and after one course and two courses of treatment, there was significant difference in them (p<0.05).Theplasma viscosity were 1.87±0.33、1.62±0.30、1.50±0.20 before thetreatment and after one and two courses of in control group, there wassignificant difference in them (p<0.05). The plasma viscosity of studygroup were lower than the control group, there was significantdifference(p<0.05).3. The concentration of and blood calcium of the study group were2.49±0.18mmol/l、2.47±0.27 mmol/l、2.50±0.26 mmol/l before thetreatment and after one course and two courses of treatment,there was nosignificant difference in them (p>0.05), the concentration of bloodcalcium of the control group were 2.51±0.26 mmol/l、2.48±0.30mmol/l、2.64±0.17mmol/l before the treatment and after one course and twocourses of treatment,there was significant difference between one courseand two courses of treatment (p<0.05),the concentration of blood calciumof the control group before the treatment was different with two coursesof treatment (p<0.05). The concentration of blood calcium of study groupwere lower than the control group after two courses of treatment, therewas significant difference(p<0.05).4.The concentration of and tartrate-resistand acid phosphatase(TRAP)of the study group were 4.35±0.53u/l、4.60±0.74u/l, 4.55±0.56u/l beforethe treatment and after one course and two courses of treatment,there wasno significant difference in them (p>0.05), the concentration of TRAP ofthe control group were 4.28±0.70u/l、5.16±0.59u/l、6.52±0.51 u/l beforethe treatment and after one course and two courses of treatment,there wassignificant difference in them (p<0.05). The concentration of TRAP ofstudy group was lower than the control group after one course and twocourses of treatment, there was significant difference(p<0.05).5. The pregnancy outcomes were 50% and 70% and no differencewas noted for pregnancy outcomes between the study group and controlgroup (p>0.05).Conclusions:1. There was no significant difference in the Clearance rate ofanticardiolipin antibody and pregnancy outcomes between the the therapy with low-molecular heparin and prednisone and aspirin.2. The therapy with low-molecular heparin is better thanprednisone and aspirin to cut down plasma viscosity.3. The influence of low-molecular heparin to bone metabolismwas lower than prednisone and aspirin.4. Tartrate-resistand acid phosphatasewe should test to diagnoseosteoporosis.更多还原