[1]欧玉华,张建平*.低分子肝素在复发性流产中应用的现状研究[J].中国计划生育和妇产科,2017,(10):10-15.
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低分子肝素在复发性流产中应用的现状研究
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《中国计划生育和妇产科》[ISSN:1674-4020/CN:51-1708/R]

卷:
期数:
2017年10期
页码:
10-15
栏目:
综述
出版日期:
2017-10-25

文章信息/Info

作者:
欧玉华张建平*
中山大学孙逸仙纪念医院妇产科
关键词:
妊娠低分子肝素复发性流产血栓前状态
分类号:
R 714.21
摘要:
低分子肝素(low molecular weight heparin,LMWH)为妊娠期首选抗凝药物,安全性高、不良反应少。复发性流产(recurrent spontaneous abortion, RSA)是一种常见的妊娠相关疾病,国内外研究认为其与血栓前状态(pre-thrombotic state,PTS)密切相关。对于PTS引起的RSA,抗凝治疗被认为是有效的治疗方法。近年研究发现,LMWH除了经典抗凝作用外,还具有促进滋养细胞增殖、分化和侵袭等重要作用,可降低再次妊娠丢失率,改善妊娠结局,但仍备受争议,需要更完善的循证医学证据来证实其有效性。本文旨在总结LMWH在RSA领域的应用现况,促进临床更合理用药。

参考文献/References:

[1]YURDAKK M. Fetal and neonatal effects of anticoagulants used in pregnancy: a review [J]. The Turkish Journal of Pediatrics, 2012, 54(3): 207-215. [2]BRANCH D W, GIBSON M, SILVER R M. Clinical practice. Recurrent miscarriage [J]. The New England Journal of Medicine, 2010, 363(18): 1740-1747. [3]WEITZ J. Low molecular weight heparins[J]. Reactions Weekly, 2006, 1132(1): 16. [4]NELSON S M, GREER I A. The potential role of heparin in assisted conception[J]. Human Reproduction Update, 2008, 14(6): 623-645. [5]BENNETT S A, BAGOT C N, ARYA R. Pregnancy loss and thrombophilia: the elusive link[J]. British Journal of Haematology, 2012, 157(5): 529-542. [6]林其德,苏小玲.抗磷脂抗体相关性复发性流产的诊治 [J].中国实用妇科与产科杂志,2013,29(2):106-108. [7]FRANKLIN R D, KUTTEH W H. Effects of unfractionated and low molecular weight heparin on antiphospholipid antibody binding in vitro [J]. Obstetrics and Gynecology, 2003, 101(3): 455-462. [8]XIE Hongxiang, ZHOU Hong, WANG Haibo, et al. Anti-β(2)GPI/β(2)GPI induced TF and TNF-α expression in monocytes involving both TLR4/MyD88 and TLR4/TRIF signaling pathways[J]. Molecular Immunology, 2013, 53(3): 246-254. [9]CHEN Ying, WU Xiao-xia, TAN Jian-ping, et al. Effects of low molecular weight heparin and heparin-binding epidermal growth factor on human trophoblast in first trimester[J]. Fertility and Sterility, 2012, 97(3): 764-770. [10]D'IPPOLITO S, DI NICUOLO F, MARANA R, et al. Emerging nonanticoagulant role of low molecular weight heparins on extravillous trophoblast functions and on heparin binding-epidermal growth factor and cystein-rich angiogenic inducer 61 expression [J]. Fertility and Sterility, 2012, 98(4): 1028-1036.e1. [11]OZBILGIN K, KARACA F, TURAN A, et al. The higher heparin-binding epidermal growth factor (HB-EGF) in missed abortion[J]. Taiwanese Journal of Obstetrics & Gynecology, 2015, 54(1): 13-18. [12]NOBLE L S, KUTTEH W H, LASHEY N, et al. Antiphospholipid antibodies associated with recurrent pregnancy loss: prospective, multicenter, controlled pilot study comparing treatment with low-molecular-weight heparin versus unfractionated heparin [J]. Fertility and Sterility, 2005, 83(3): 684-690. [13]FAWAD S. Role of anti-thrombotic therapy for recurrent pregnancy loss due to anti-phospholipid syndrome [J]. Journal of Ayub Medical College, Abbottabad : JAMC, 2012, 22(3): 197-200. [14]ALALAF S. Bemiparin versus low dose aspirin for management of recurrent early pregnancy losses due to antiphospholipd antibody syndrome [J]. Archives of Gynecology and Obstetrics, 2012, 285(3): 641-647. [15]EMPSON M B, LASSERE M, CRAIG J C, et al. Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant[J]. The Cochrane Database of Systematic Reviews, 2005, 18(2): CD002859. [16]FOUDA U M, SAYED A M, ABDOU A M, et al. Enoxaparin versus unfractionated heparin in the management of recurrent abortion secondary to antiphospholipid syndrome[J]. International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics, 2011, 112(3): 211-215. [17]BULLETIN A P. 118:antiphospholipid syndrome[J]. Obstetrics and Gynecology, 2011, 117(1): 192-199. [18]MOUSA H A, ALFIREVIC1 Z. Do placental lesions reflect thrombophilia state in women with adverse pregnancy outcome?[J]. Human Reproduction (Oxford, England), 2000, 15(8): 1830-1833. [19]NELEN W L, BLOM H J, STEEGERS E A, et al. Hyperhomocysteinemia and recurrent early pregnancy loss:a meta analysis[J]. Fertility and Sterility, 2000, 74(6): 1196-1199. [20]KRABBENDAM I, FRANX A, BOTS M L, et al. Thrombophilias and recurrent pregnancy loss: a critical appraisal of the literature[J]. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2005, 118(2): 143-153. [21]CHECK J H. The use of heparin for preventing miscarriage [J]. American Journal of Reproductive Immunology (New York, N.Y.:1989), 2012, 67(4): 326-333. [22]ARACIC N, ROJE D, DRMIC HOFMAN I, et al. Low molecular weight heparin treatment and impact of inherited thrombophilia type in pregnancies with previous adverse outcome[J]. The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2015, 28(3): 306-310. [23]ARACIC N, ROJE D, JAKUS I A, et al. The impact of inherited thrombophilia types and low molecular weight heparin treatment on pregnancy complications in women with previous adverse outcome[J]. Yonsei Medical Journal, 2016, 57(5): 1230-1235. [24]KARADAG C, YOLDEMIR T, KARADAG S D, et al. Obstetric outcomes of recurrent pregnancy loss patients diagnosed with inherited thrombophilia[J]. Irish Journal of Medical Science, 2017,186(3):707-713. [25]AREIA A L, FONSECA E, AREIA M, et al. Low-molecular-weight heparin plus aspirin versus aspirin alone in pregnant women with hereditary thrombophilia to improve live birth rate: meta-analysis of randomized controlled trials[J]. Archives of Gynecology and Obstetrics, 2016, 293(1): 81-86. [26]DE JONG P G, QUENBY S, BLOEMENKAMP K W, et al. ALIFE2 study: low-molecular-weight heparin for women with recurrent miscarriage and inherited thrombophilia——study protocol for a randomized controlled trial[J]. Trials, 2015, 16: 208. [27]BRUSILOVSKY M, CORDOBA M, ROSENTAL B, et al. Genome-wide siRNA screen reveals a new cellular partner of NK cell receptor KIR2DL4: heparan sulfate directly modulates KIR2DL4-mediated responses[J]. Journal of Immunology (Baltimore, Md. : 1950), 2013, 191(10): 5256-5267. [28]FLUHR H, SPRATTE J, EHRHARDT J, et al. Heparin and low-molecular-weight heparins modulate the decidualization of human endometrial stromal cells [J]. Fertility and Sterility, 2010, 93(8): 2581-2587. [29]LULEY L, SCHUMACHER A, MULLA M J, et al. Low molecular weight heparin modulates maternal immune response in pregnant women and mice with thrombophilia[J]. American Journal of Reproductive Immunology (New York, N.Y. : 1989), 2015, 73(5): 417-427. [30]SHOMER E, KATZENELL S, ZIPORI Y, et al. Microvesicles of pregnant women receiving low molecular weight heparin improve trophoblast function [J]. Thrombosis Research, 2016, 137: 141-147. [31]YUKSEL H, KAYATAS S, BOZA A T, et al. Low molecular weight heparin use in unexplained recurrent miscarriage[J]. Pakistan Journal of Medical Sciences, 2015, 30(6): 1232-1237. [32]SHAABAN O M, ABBAS A M, ZAHRAN K M, et al. Low-Molecular-Weight heparin for the treatment of unexplained recurrent miscarriage with negative antiphospholipid antibodies[J]. Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, 2017,23(6):567-572. [33]SESHADRI S, SUNKARA S K, KHALAF Y, et al. Effect of heparin on the outcome of IVF treatment: a systematic review and meta-analysis [J]. Reproductive BioMedicine Online, 2012, 25(6): 572-584. [34]SCHLEUSSNER E, KAMIN G, SELIGER G, et al. Low-molecular-weight heparin for women with unexplained recurrent pregnancy loss: a multicenter trial with a minimization randomization scheme[J]. Annals of Internal Medicine, 2015, 162(9): 601-609. [35]CHECK J H. The use of heparin for preventing miscarriage [J]. American Journal of Reproductive Immunology (New York, N.Y. : 1989), 2012, 67(4): 326-333. [36]GALARZA-MALDONADO C, KOURILOVITCH M R, PREZ-FERNNDEZ O M, et al. Obstetric antiphospholipid syndrome[J]. Autoimmunity Reviews, 2012, 11(4): 288-295. [37]MT1 D S. Khalid S,christos PJ.outcomes in women receiving low-molecular-weight heparin during pregnancy[J]. Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis, 2012, 23(8): 751-755.

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更新日期/Last Update: 2017-10-25