阿司匹林联合低分子肝素对胎儿生长受限孕妇子宫动脉及脐动脉血流的影响

doi:10.3760/cma.j.cn441417-20240929-16005

摘要/Abstract

摘要：

目的　分析阿司匹林联合低分子肝素对胎儿生长受限（FGR）孕妇子宫动脉、脐动脉血流及妊娠结局的影响。方法　采用前瞻性研究，选取2021年5月至2023年5月于宝鸡市人民医院确诊为FGR孕妇104例，随机数字表法分为阿司匹林联合低分子肝素治疗组（联合组，52例）及单用低分子肝素治疗组（对照组，52例）。比较治疗前后两组孕妇子宫动脉、脐动脉血流变化［搏动指数（PI）、阻力指数（RI）、收缩期最大血流速度与舒张末期血流速度比值（S/D）］及新生儿情况（体重、身长、呼吸评分）、妊娠不良结局。采用t检验、χ²检验进行统计分析。结果　治疗后，联合组孕妇子宫动脉、脐动脉血流参数PI、RI、S/D均低于治疗前（均P<0.05），且联合组低于对照组（1.03±0.33比1.17±0.35、0.67±0.13比0.79±0.11、2.46±0.59比2.69±0.51、0.72±0.26比0.83±0.23、0.61±0.11比0.71±0.10、2.17±0.43比2.39±0.37），差异均有统计学意义（均P<0.05）。联合组新生儿体重为（3 182.98±578.94）g、身长为（49.53±2.62）cm、1 min Apgar评分为（9.28±0.47）分、不良妊娠结局发生率为13.46%（7/52），对照组分别为（2 836.63±569.13）g、（47.25±2.71）cm、（8.71±0.64）分、30.77%（16/52），两组比较差异均有统计学意义（均P<0.05）。结论　阿司匹林联合低分子肝素治疗可改善FGR孕妇的血流参数，促进血液循环和胎儿发育，改善妊娠结局。

关键词:

胎儿生长受限, 子宫动脉血流, 脐动脉血流, 阿司匹林, 低分子肝素, 预后

Abstract:

Objective　To analyze the effects of aspirin and low molecular weight heparin on uterine artery and umbilical artery blood flow and pregnancy outcomes in women with fetal growth restriction (FGR). Methods　This was a prospective study. From May 2021 to May 2023, 104 women diagnosed with FGR at Baoji People's Hospital were selected, and divided into an aspirin combined with low molecular weight heparin group (a combined group) and a low molecular weight heparin alone group (a control group) by the random number table method, with 52 cases in each group. The changes of uterine artery and fetal umbilical artery blood flow [pulsatility index (PI), resistance index (RI), and the ratio of maximum systolic blood flow velocity to end-diastolic blood flow velocity (S/D)] before and after the treatment, the physical health conditions of the newborns at birth (body weight, body length, and respiratory score), and adverse pregnancy outcomes were compared between the two groups by t test and χ² test. Results　After the treatment, the blood flow parameters PI, RI, and S/D of the uterine artery and fetal umbilical artery in the combined group were lower than those before the treatment, and were lower than those in the control group (1.03±0.33 vs. 1.17±0.35, 0.67±0.13 vs. 0.79±0.11, 2.46±0.59 vs. 2.69±0.51, 0.72±0.26 vs. 0.83±0.23, 0.61±0.11 vs. 0.71±0.10, and 2.17±0.43 vs. 2.39±0.37), with statistical differences (all P<0.05). The neonatal weight , length, 1 min Apgar score, and incidence rate of adverse pregnancy outcomes in the combined group were better than those in the control group [(3 182.98±578.94) g vs. (2 836.63±569.13) g, (49.53±2.62) cm vs. (47.25±2.71) cm, 9.28±0.47 vs. 8.71±0.64, 13.46% (7/52) vs. 30.77% (16/52)], with statistical differences (all P<0.05). Conclusion　Aspirin combined with low molecular weight heparin for women with FGR can improve their blood flow parameters and blood circulation, fetal development, and pregnancy outcomes.

Key words:

Fetal growth restriction, Uterine artery blood flow, Umbilical artery blood flow, Aspirin, Low molecular weight heparin, Prognosis

王格丽李培英时瑞娟任建利.

阿司匹林联合低分子肝素对胎儿生长受限孕妇子宫动脉及脐动脉血流的影响 [J]. 国际医药卫生导报, 2025, 31(16): 2663-2667.

Wang Geli, Li Peiying, Shi Ruijuan, Ren Jianli.

Influence of aspirin and low molecular weight heparin on uterine artery and umbilical artery blood flow in women with fetal growth restriction [J]. International Medicine and Health Guidance News, 2025, 31(16): 2663-2667.

参考文献

[1] 陈瑞欣, 漆洪波, 刘兴会. 2021年美国妇产科医师协会胎儿生长受限指南解读[J]. 实用妇产科杂志, 2021, 37(12): 907-909.
[2] Melamed N, Baschat A, Yinon Y, et al. FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction[J]. Int J Gynaecol Obstet, 2021, 152(S1): 3-57. DOI: 10.1002/ijgo.13522.
[3] Vaughan OR, Maksym K, Silva E, et al. Placenta-specific Slc38a2/SNAT2 knockdown causes fetal growth restriction in mice[J]. Clin Sci, 2021, 135(17): 2049-2066. DOI: 10.1042/CS20210575.
[4] Resnik R. Intrauterine growth restriction[J]. Obstet Gynecol, 2002, 14(2):127-135.
[5] Sun LQ. The update of fetal growth restriction associated with biomarkers[J]. Matern Fetal Med, 2022, 4(3): 210-217. DOI: 10.1097/FM9.0000000000000156.
[6] Kingdom J, Ashwal E, Lausman A, et al. Guideline no. 442: fetal growth restriction: screening, diagnosis, and management in singleton pregnancies[J]. J Obstet Gynaecol Can, 2023, 45(10): 102154. DOI: 10.1016/j.jogc.2023.05.022.
[7] 柯抒晨, 许张晔. 低分子肝素联合小剂量阿司匹林对复发性流产患者凝血指标及Th17/Treg细胞因子的影响[J]. 中国计划生育学杂志, 2021, 29(3): 461-465. DOI: 10.3969/j.issn.1004-8189.2021.03.008.
[8] 徐丽娟, 傅向红, 纪毅梅, 等. 阿司匹林联合低分子肝素改善子痫前期母婴预后的临床应用价值[J]. 中国妇幼保健, 2021, 36(10): 2212-2215. DOI: 10.19829/j.zgfybj.issn.1001-4411.2021.10.006.
[9] 段涛, 杨慧霞, 胡娅莉, 等. 胎儿生长受限专家共识(2019版)[J/OL]. 中国产前诊断杂志(电子版), 2019, 11(4): 78-98[2024-08-28]. https://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_zgcqzdzz201904019&dbid=WF_QK.DOI: 10.13470/j.cnki.cjpd.2019.04.017.
[10] 万书婷, 王谢桐. 子宫动脉血流监测在产科的应用[J]. 中国实用妇科与产科杂志, 2022, 38(4): 403-406. DOI: 10.19538/j.fk2022040106.
[11] Blue NR, Beddow ME, Savabi M, et al. A comparison of methods for the diagnosis of fetal growth restriction between the royal college of obstetricians and gynaecologists and the American college of obstetricians and gynecologists[J]. Obstet Gynecol, 2018, 131(5): 835-841. DOI: 10.1097/AOG.0000000000002564.
[12] Giouleka S, Tsakiridis I, Mamopoulos A, et al. Fetal growth restriction: a comprehensive review of major guidelines[J]. Obstet Gynecol Surv, 2023, 78(11): 690-708. DOI: 10.1097/OGX.0000000000001203.
[13] Nardozza LMM, Caetano ACR, Zamarian ACP, et al. Fetal growth restriction: current knowledge[J]. Arch Gynecol Obstet, 2017, 295(5): 1061-1077. DOI: 10.1007/s00404-017-4341-9.
[14] Nowakowska BA, Pankiewicz K, Nowacka U, et al. Genetic background of fetal growth restriction[J]. Int J Mol Sci, 2021, 23(1): 36. DOI: 10.3390/ijms23010036.
[15] Groene SG, Spekman JA, Te Pas AB, et al. Respiratory distress syndrome and bronchopulmonary dysplasia after fetal growth restriction: lessons from a natural experiment in identical twins[J]. EClinicalMedicine, 2021, 32: 100725. DOI: 10.1016/j.eclinm.2021.100725.
[16] Pels A, Knaven OC, Wijnberg-Williams BJ, et al. Neurodevelopmental outcomes at five years after early-onset fetal growth restriction: analyses in a Dutch subgroup participating in a European management trial[J]. Eur J Obstet Gynecol Reprod Biol, 2019, 234: 63-70. DOI: 10.1016/j.ejogrb.2018.12.041.
[17] Crispi F, Bijnens B, Figueras F, et al. Fetal growth restriction results in remodeled and less efficient hearts in children[J]. Circulation, 2010, 121(22): 2427-2436. DOI: 10.1161/CIRCULATIONAHA.110.937995.
[18] 王程锦. 胎儿生长受限对胎儿危害的临床研究[J/OL]. 国际感染病学(电子版), 2020, 9(1): 16[2024-08-28].https://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_gjgrzz-d202001011&dbid=WF_QK.
[19] 蒋晨昱, 鲍晨怡, 刘兴会. 胎儿生长受限的诊治[J]. 实用妇产科杂志, 2020, 36(3): 170-173.
[20] 许安立, 刘丝荪, 王芬. 胎儿生长受限诊断与监测的研究进展[J]. 实用临床医学, 2022, 23(1): 131-134, 138. DOI: 10.13764/j.cnki.lcsy.2022.01.037.
[21] 符建, 杨月华, 陈亮, 等. 子宫动脉和脐动脉血流动力学参数对晚发型胎儿宫内生长受限的预测价值[J]. 中国超声医学杂志, 2021, 37(9): 1035-1039. DOI: 10.3969/j.issn.1002-0101.2021.09.023.
[22] 理国富, 陈奡, 邓旺斌, 等. 低分子肝素介导TLR4/MYD88/NF-κB通路保护PC12细胞拮抗氧糖剥夺诱导的炎症反应[J]. 中国医师杂志, 2021, 23(6): 848-852, 858. DOI: 10.3760/cma.j.cn431274-20200915-01288.
[23] 李春英, 陈少慧, 李海静, 等. 胎儿生长受限与孕妇抗凝血酶Ⅲ、蛋白C、D-二聚体相关性及抗凝治疗效果[J]. 中国计划生育学杂志, 2020, 28(9): 1420-1424. DOI: 10.3969/j.issn.1004-8189.2020.09.021.
[24] 王倩, 石珊, 于艳美, 等. 脑胎盘率及子宫动脉联合检测对晚发型胎儿生长受限预后评估的临床意义[J]. 医学影像学杂志, 2022, 32(6): 1015-1018.
[25] 胡颖. 阿司匹林联合低分子肝素治疗胎儿生长受限的疗效及对妊娠结局的影响[J]. 医学理论与实践, 2024, 37(3): 450-453. DOI: 10.19381/j.issn.1001-7585.2024.03.034.