CAJ | 학술논문

目的：探讨妊娠早期先兆流产患者凝血功能、内分泌及免疫状态，以及低分子量肝素对其临床疗效。方法选择同期住院保胎治疗的78例妊娠早期先兆流产孕妇，其中复发性自然流产（RSA）者35例（A组）、有1次早期自然流产史者20例（B 组）、无自然流产史者23例（C组），分别检测各组孕妇的D-二聚体水平，抗心磷脂抗体三项、风湿免疫全套、生殖细胞相关抗体等自身免疫抗体和抗甲状腺抗体及CD3-CD16＋CD56＋NK细胞比例，对A、B组存在高凝状态及免疫因素的患者予低分子量肝素、人绒促性素、黄体酮等治疗，C组予人绒促性素、黄体酮治疗，观察妊娠结局。结果 A、B组孕妇D-二聚体水平明显高于C组（P均＜0.017），A、B组间比较差异均无统计学意义（P＞0.017）。A组抗甲状腺抗体阳性率高于C组（P均＜0.017）。A、B组NK细胞表面标记CD3-CD16＋CD56＋比例均高于正常参考值范围，但两组比较差异无统计学意义（P＞0.05）。A、B、C 组的妊娠成功率分别为83％、76％、87％，3组比较差异无统计学意义（P＞0.05）。结论在妊娠早期有自然流产史的先兆流产患者处于轻度高凝、免疫紊乱状态，应用低分子量肝素治疗有助成功妊娠。
목적：탐토임신조기선조유산환자응혈공능、내분비급면역상태，이급저분자량간소대기림상료효。방법선택동기주원보태치료적78례임신조기선조유산잉부，기중복발성자연유산（RSA）자35례（A조）、유1차조기자연유산사자20례（B 조）、무자연유산사자23례（C조），분별검측각조잉부적D-이취체수평，항심린지항체삼항、풍습면역전투、생식세포상관항체등자신면역항체화항갑상선항체급CD3-CD16＋CD56＋NK세포비례，대A、B조존재고응상태급면역인소적환자여저분자량간소、인융촉성소、황체동등치료，C조여인융촉성소、황체동치료，관찰임신결국。결과 A、B조잉부D-이취체수평명현고우C조（P균＜0.017），A、B조간비교차이균무통계학의의（P＞0.017）。A조항갑상선항체양성솔고우C조（P균＜0.017）。A、B조NK세포표면표기CD3-CD16＋CD56＋비례균고우정상삼고치범위，단량조비교차이무통계학의의（P＞0.05）。A、B、C 조적임신성공솔분별위83％、76％、87％，3조비교차이무통계학의의（P＞0.05）。결론재임신조기유자연유산사적선조유산환자처우경도고응、면역문란상태，응용저분자량간소치료유조성공임신。
Objective Todiscussthecoagulationfunction,endocrineandimmunestateinearly pregnant patients with threatened abortion and evaluate the clinical efficacy of low-molecular-weight heparin.Methods Intotal,78hospitalizedwomenwiththreatenedabortionduringearlypregnancywereenrolledin this study. Thirty five patients had recurrent spontaneous abortion (group A),20 had once early spontaneous abortion (group B)and 23 had no history of spontaneous abortion (group C). D-dimer level,anticardiolipin antibody (ACA-IgA,IgG,IgM),rheumatism and immune parameters (RF,ASO,hs-CRP,IgA,IgG, IgM,C3 and C4),germ cell related antibody,anti-thyroid antibody and the proportion of CD3-CD1 6 +CD56 +NK cells were measured and statistically compared among three groups. In groups A and B,patients with hy-percoagulable state and immune disorder were administered with low-molecular-weight heparin,chorionic gona-dotrophin and progesterone,and those in group C were treated with chorionic gonadotrophin and progesterone.Pregnancyoutcomeswerecloselyobserved.Results ThelevelsofD-dimeringroupsAandBweresignificant-ly higher compared with that in group C (all P<0.01 7 ). No statistical significance was observed between groups A and B (P>0.05 ). The positive rate of anti-thyroid antibodies in A groups was significantly higher than that in group C (P<0.01 7 ). The percentage of CD3-CD1 6 +CD56 +NK cells in groups A and B was higher than normal reference value,whereas no statistical significance was noted between two groups (P>0.05 ). The success rates of pregnancy in groups A,B and C were 83%,76%and 87%with no statistical sig-nificance(P>0.05).Conclusions Patientswiththreatenedabortion,whohaveahistoryofspontaneousa-bortion during early pregnancy,have mild hypercoagulable state and immune disorder. Application of low-mo-lecular-weight heparin therapy contributes to the success of pregnancy.