Study On Aspirin Accurate Treatment For Women With High Risk Of Preeclampsia

Gestational hypertension disease(hypertensive disorders of pregnancy,HDP)is a group of disease and high blood pressure,pregnancy rate was 5% ~12%.Preeclampsia(PE)and eclampsia seriously endanger the health of mothers and infants.They can lead to new hypertension with multiple systemic involvement,damage and even failure.Worldwide,they cause more than 70,000 maternal deaths and more than500,000 neonatal and fetal deaths each year.Because PE is often accompanied by iatrogenic premature birth,fetal growth restriction,fetal distress,etc.,it directly affects the perinatal outcome,and once the clinical treatment effect is limited.At present,the pathogenesis of hypertension in pregnancy is still in the exploration stage.Studies show that 25%~65% of women with a history of PE may suffer from PE again.Many pregnant women with basic diseases are high-risk groups of PE after pregnancy,such as pregnant women with autoimmune diseases,and preventive treatment for high-risk groups can improve the pregnancy outcome.At present,aspirin preventive treatment has achieved some results,but there are many uncertainties in its drug safety,effective drug dose and drug resistance,which should be further discussed.Objective:Application of preeclampsia at higher risk of low dose aspirin antiplatelet aggregation treatment,monitoring platelet aggregation rate,analyze the high risk population of preeclampsia pregnancy clinical data and observed curative effect,at the same time for such people line of aspirin resistance genome group of detection,summarizes and discusses antiplatelet aggregation drugs in preeclampsia at higher risk preventive treatment of accurate strategy.Methods:55 patients with high risk of preeclampsia were collected as subjects(group I + group II),and 22 healthy pregnant women who were hospitalized for delivery at the same time were selected as the control group(group III).The high-risk group was divided into the high-risk intervention group(40 patients in group I)and the high-risk non-intervention group(15 patients in group II)according to whether low-dose aspirin was used or not.Platelet aggregation rate was detected in both groups after enrollment,and the anti-rheumatoid antibody,lupus anticoagulant and anti-phospholipid antibody spectrum were screened.Patients in group I were given aspirin 75 mg before 16 weeks of pregnancy(patients with antiphospholipid syndrome were treated with low molecular weight heparin),and the platelet aggregation rate(AA and ADP)was remeasured at 2 weeks and 28 weeks of pregnancy,respectively.The coagulation function was monitored during the treatment,and placental growth factor was measured at 16-20 weeks and 28 weeks of pregnancy,respectively.Stop aspirin at 32 weeks of gestation or 1 week before delivery,and stop low-molecular-weight heparin at 24 hours before delivery.Blood samples were taken to detect the gene sites associated with aspirin resistance.Patients in group II were followed up to the end of pregnancy with symptomatic support therapy.The platelet aggregation rate and maternal and infant outcomes of the high-risk population with preeclampsia were analyzed and compared with the control group.The differences of genotype frequency and allele frequency between aspirin resistance and sensitive population were analyzed,and the correlation between aspirin resistance and gene polymorphism in high-risk population of preeclampsia was discussed.Results:Tianjin medical university general hospital obstetrics on March 1,2019 to March 1,2020 in our hospital during outpatient treatment and hospital births in patients at high risk of 55 cases of PE(I + II group),40 patients who received low-dose aspirin preventive treatment(group I),contains the usual,a total of 20 patients with early onset preeclampsia(screening out of 7 cases for antiphospholipid syndrome patients,2 cases of connective tissue disease),for antiphospholipid syndrome in patients with a total of 19 cases,connective tissue disease in 4 cases,a total of 6 cases of systemic lupus erythematosus(sle),a total of 6 cases of patients with chronic hypertension.T test was performed on the data of groups I,II and III,and there was no statistically significant difference in age,pregnancy and delivery(p>0.05).There was no significant difference in platelet aggregation rates between the two groups before aspirin use(p>0.05).Platelet aggregation rates of patients in group I were compared before and after aspirin use,and the difference of aa-induced platelet aggregation rates was statistically significant(p<0.05),the difference of platelet aggregation rate induced by ADP was statistically significant(p<0.05),and the decrease of AA was significantly higher than that of ADP,but 4 patients failed to decrease effectively and developed aspirin resistance.The platelet aggregation rates of patients in group I who were continuously taking aspirin up to the 28 th week of pregnancy were compared with those who were only used aspirin for 2 weeks,and the differences were not statistically significant(p>0.05).Placental growth factors were measured at different gestational weeks in patients in group I,and the eligibility rates of patients in these two periods were calculated.The results showed that 82.50%and 80% of patients were higher than the lowest standard values in the second and third trimester,respectively.The PE incidence,gestational age and stillbirth rate of patients in groups I,II and III were compared,and the difference was statistically significant(p<0.05).The difference of cesarean section rate between the three groups was not statistically significant(p>0.05).Further examination showed that the incidence of PE and stillbirth in group II was significantly higher than that in group I,and the gestational age of delivery was significantly lower than that in group I.Four patients in group I had AR,but none of them had PE in this pregnancy.In addition,6patients in group I were diagnosed with PE recurrence.The average gestational week of onset of PE in the previous pregnancy was about 32 weeks,and the average gestational week of onset of PE in this pregnancy was about 34 weeks.Neonatal transfer rates of patients in groups I,II and III were compared,and the differences were statistically significant(p<0.05);However,the differences in neonatal asphyxia rate and neonatal mortality between the three groups were not statistically significant(p>0.05).Further examination showed that the neonatal transfer rate of patients in group II was significantly higher than that in group I.In addition,no abnormalities,aspirin-related bleeding events or thrombocytopenia were found in all neonates in group I in this study.High-risk intervention group(group I)according to the different risk factors can be divided into typical or atypical APS patients(group A),(group B)merge SLE or CTD patients,patients with chronic hypertension(group C),(group D)always early onset patients with PE,four groups of patients the incidence of PE,childbirth,gestational age,the incidence of stillbirth and neonatal asphyxia rate,the rate of neonatal change one’s major differences were not statistically significant(p>0.05);Differences in neonatal mortality were only statistically significant(p<0.05).Patients in group I were monitored for normal coagulation function during medication,and no abnormal bleeding events were found during all gestation periods.The difference in blood loss during delivery between high-risk PE patients and healthy people was not statistically significant(p=0.328).Among the 40 patients in group I,36 were sensitive to aspirin.The platelet aggregation rate of 4 patients after aspirin use was consistent with the laboratory diagnostic criteria,presenting as aspirin resistance in AR group.The genotype frequency and allele frequency of cox-1 A842 G,GPIIIa and P2Y1 loci in AR group and AS group were not statistically significant.No gene polymorphism was found at the cox-1 A842 G locus in the AR group,all genotypes were AA,no gene polymorphism was found at the GPIIIa locus,all genotypes were TT,and polymorphism of this gene locus could be seen at the P2Y1 locus,namely GA and AA genotypes.Conclusion: 1.The common risk factors of preeclampsia include previous history of preeclampsia,chronic hypertension,autoimmune diseases such as systemic lupus erythematosus or antiphospholipid syndrome,multiple pregnancy and diabetes mellitus.There is a certain recurrence rate of preeclampsia,so attention should be paid to high-risk groups and immune-related screening should be done.2.Aspirin can play a certain role in preventing or delaying the onset of preeclampsia in the population with high risk of preeclampsia pregnancy,so as to improve maternal and infant outcomes.3.Clinical and biochemical monitoring of platelet aggregation rate,placental growth factor and other aspects should be carried out during the application of aspirin in high-risk groups of preeclampsia,and accurate regulation should be carried out according to the condition.4.People at high risk of preeclampsia may be generally sensitive to aspirin,so it is necessary to expand the population or find new gene loci to draw more conclusions on the correlation between aspirin resistance and gene polymorphism in Chinese pregnancy population.