低分子肝素联合硫酸镁治疗重度妊娠期高血压疾病对血清PLGF、sFit-1水平及胎儿生长受限的影响

Effects of low molecular weight heparin combined with magnesium sulfate on serum levels of PLGF, sFit-1 and fetal growth restriction in severe HDCP

摘要

目的 探究低分子肝素(LMWH)联合硫酸镁治疗重度妊娠期高血压对血液流变学、子宫动脉阻力指数、胎盘生长因子(PLGF)、可溶性血管内皮生长因子受体-1(sFit-1)水平及胎儿生长受限的影响。方法 选择2022年6月至2024年6月在保定市妇幼保健院分娩的140例重度妊娠期高血压患者作为研究对象,随机分为研究组与对照组各70例。对照组单用硫酸镁注射液治疗,研究组在对照组基础上联合LMWH皮下注射治疗,比较两组患者的血液流变学[(全血高切粘度(MS)、全血低切粘度(LS)、血浆粘度(PV)、红细胞压积(HT)、血沉(ESR)]、血压[收缩压(SBP)、舒张压(DBP)]、子宫血流动力学指标[子宫动脉血流搏动指数(PI)、子宫动脉阻力指数(RI)及动脉血流峰谷比(S/D)]、PLGF、sFit-1水平及胎儿生长受限等情况。结果 治疗后,两组患者MS、LS、PV、HT和ESR均有所降低,且研究组低于对照组,差异有统计学意义(t值介于3.122~9.275之间,P<0.05);治疗后,两组患者SBP、DBP均有所降低,且研究组低于对照组,差异有统计学意义(t值分别为4.472、8.510,P<0.05);治疗后,两组RI、PI、S/D水平均有所降低,且研究组低于对照组,差异有统计学意义(t值介于4.084~22.958之间,P<0.001);治疗后,两组PLGF水平均有所升高,且研究组高于对照组,差异有统计学意义(t=9.332,P<0.05);治疗后,两组sFit-1水平均有所降低,且研究组低于对照组,差异有统计学意义(t=5.012,P<0.05);研究组胎儿生长受限发生率低于对照组,差异有统计学意义(25.71% vs. 45.71%,χ²=6.098,P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论 LMWH联合硫酸镁能够改善血液流变学指标,维持血压稳定,降低子宫动脉血流阻力,改善PLGF、sFit-1水平及母婴结局。

Abstract

Objective To investigate effects of low molecular weight heparin (LMWH) combined with magnesium sulfate on hemorheology, uterine artery resistance index (RI), placental growth factor (PLGF) and soluble vascular endothelial growth factor receptor-1 (also called soluble fms-like tyrosine kinase-1, sFit-1) and fetal growth restriction in severe hypertensive disorders complicating pregnancy (HDCP). Methods A total of 140 patients with severe HDCP who delivered in our hospital over a period from June 2022 to June 2024 were enrolled as research subjects. According to random number table method, they were divided into study group and control group, 70 cases in each group. The patients in the control group were treated with magnesium sulfate injection, while the patients in the study group were additionally given subcutaneous injection of LMWH on basis of magnesium sulfate injection. The hemorheological indexes [whole blood high-shear viscosity (HS), low-shear viscosity (LS), plasma viscosity (PV), hematocrit (HT), erythrocyte sedimentation rate (ESR)], blood pressure [systolic blood pressure (SBP), diastolic blood pressure (DBP)], uterine hemodynamic indexes [uterine artery pulsatility index (PI), resistance index (RI), systolic and diastolic blood flow velocity ratio (S/D)], serum levels of PLGF, sFit-1 and fetal growth restriction were compared between the two groups. Results After treatment, MS, LS, PV, HT and ESR of the patients decreased in both the two groups, and those in the study group were lower than those in the control group (t=4.831, 3.216, 4.196, 9.275 and 3.122 respectively, all P<0.05). After treatment, SBP and DBP of the patients in both two groups descended, and the SBP and DBP of the patients in the study group were lower than those in the control group (t=4.472 and 8.510 respectively, both P<0.05). After treatment, levels of RI, PI and S/D were decreased in both two groups, and these indexes were lower in the study group than those in the control group (t=22.958, 4.084 and 14.486 respectively, all P<0.05). After treatment, the serum PLGF level of the patients in both two groups elevated, and the serum PLGF level of the patients in the study group was higher than that in the control group (t=9.332, P<0.05). While after treatment, the serum sFit-1 level of the patients in both two groups descended, and the serum sFit-1 level of the patients in the study group was lower than that in the control group (t=5.012, P<0.05). The incidence of fetal growth restriction in the study group was lower than that in the control group (25.71% vs 45.71%, χ²=6.098, P<0.05). There was no significant difference in incidence of adverse reactions between the two groups (χ²=0.122, P>0.05). Conclusion Low molecular weight heparin combined with magnesium sulfate can improve hemorheological indexes of the patients with HDCP, maintain stability of blood pressure, reduce uterine artery flow resistance, improve serum PLGF and sFit-1 level, and maternal and neonatal outcomes.

关键词

妊娠期高血压 / 低分子肝素 / 硫酸镁 / 血液流变学 / 子宫动脉阻力指数 / 胎盘生长因子 / 可溶性血管内皮生长因子受体-1 / 胎儿生长受限

Key words

hypertensive disorder complicating pregnancy / low molecular weight heparin / magnesium sulfate / hemorheology / uterine artery resistance index / placental growth factor / soluble vascular endothelial growth factor receptor-1 / fetal growth restriction

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基金资助

保定市科技计划自筹经费项目(2241ZF084)