| Objective: The aim of this study is to evaluate the efficacy of hydroxychloroquine(HCQ)combined with low molecular weight heparin(LMWH)in patients with recurrent spontaneous abortion(RSA)with antinuclear antibody(ANA)positive by retrospective analysis,to provide ideas for the treatment of such patients in clinical practice.Methods: A total of 109 RSA patients with ANA-positive who were treated in the Department of Qingdao Municipal Hospital from 2018 to 2022 were retrospectively selected.According to the different treatments used during their visits,they were grouped into 39 cases in the progesterone therapy group,33 cases in the progesterone therapy plus low molecular weight heparin(LMWH group)and 37 cases in the progestin therapy plus hydroxychloroquine combined with low molecular weight heparin(combined medication group),and 70 cases of pregnant women of childbearing age without adverse pregnancy history during the same period were selected as the negative control group.By querying the outpatient and inpatient electronic medical record workstation of Qingdao Municipal Hospital,the Ruimei Test Report Query System and telephone follow-up:1.The basic clinical data of the four groups of patients were compared.2.The coagulation indexes including D-dimer(D-D),prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB)were compared in each group of RSA patients before and after treatment.3.The levels of human chorionic gonadotropin(β-HCG)were compared in each group of RSA patients before and after treatment.4.The incidence of pregnancy complications such as gestational hypertension,oligohydramnios,fetal growth restriction,and liver function abnormalities was compared among the four groups of patients.5.The pregnancy outcomes including abortion,intrauterine fetal death,premature delivery,full-term live birth rate,mode of delivery including vaginal delivery rate,cesarean section rate and the birth weight of the newborns were compared among the four groups of patients.Result1.There were no significant differences in age,BMI,and number of births among the patients in the progesterone therapy group,LMWH group,combined medication group,and negative control group(P>0.05);There were no significant differences in the number of pregnancies and number of spontaneous abortions among the progesterone therapy group,LMWH group and combined medication group(P>0.05),but they were all higher than those in the negative control group(P<0.05).Compared with the negative control group,the gestational age of termination of pregnancy in the progesterone therapy group was shortened(P<0.05).2.Before treatment,no significant differences in D-D,APTT,PT,TT and FIB among the patients in the progesterone therapy group,the LMWH group and the combined medication group(P>0.05);After treatment,compared with the progesterone therapy group,D-D and FIB were significantly decreased,PT,APTT and TT were significantly prolonged in LMWH group and the combined medication group(P<0.05).Compared with the LMWH group,the PT and APTT in the combined medication group were significantly prolonged after treatment(P<0.05),and there was no significant difference in the remaining indicators between the two groups(P>0.05);Compared with before treatment,D-D and FIB were significantly decreased,PT,APTT and TT were significantly prolonged in LMWH group and the combined medication group after treatment(P<0.05),however,no significant differences in D-D,APTT,PT and FIB in the progesterone therapy group before and after treatment(P>0.05),and differences in TT before and after treatment(P<0.05).3.There was no significant difference in β-HCG before treatment(5 weeks of gestation)among the patients in the progesterone therapy group,the LMWH group and the combined medication group(P>0.05);After treatment(8 weeks of pregnancy),compared with the progesterone therapy group,the β-HCG of the combined medication group was significantly higher(P<0.05);After treatment,the increased amplitude ofβ-HCG after treatment was more pronounced in the combined medication group compared to the progesterone therapy group(P<0.05).4.Birth weight of the newborns in the LMWH group,the combined medication group and the negative control group were significantly higher than that in the progesterone therapy group(P<0.05);No obvious differences in premature delivery and mode of delivery among the patients in the progesterone therapy group,the LMWH group,the combined medication group and the negative control group(P>0.05).The incidence of pregnancy complications was 43.59%,33.33%,16.22% and 14.29% in the progesterone therapy group,the LMWH group,the combined medication group and the negative control group,respectively,with significant differences(P<0.05);The incidence of hypertension during pregnancy was 15.38%,6.06%,2.70% and 0 respectively,with significant differences(P<0.05);The full-term live birth rates of the four groups were64.10%,75.76%,89.19% and 92.86%,respectively,with significant differences(P<0.05).The rates of abortion(including intrauterine fetal death)in the four groups were 28.21%,15.15%,5.41% and 4.29%,respectively,with significant differences(P<0.05).Conclusion1.Addition of LMWH or HCQ combined with LMWH on the basis of progesterone therapy can significantly improve the coagulation function of RSA patients,but HCQ combined with LMWH has a better effect.2.HCQ combined with LMWH can increase the level of β-HCG in the early pregnancy of ANA-positive RSA patients,which is beneficial to the maintenance of pregnancy.3.HCQ combined with LMWH is effective in the treatment of ANA-positive RSA patients,which can improve the full-term live birth rate,reduce the abortion rate,and reduce the occurrence of pregnancy complications.4.Compared with normal pregnancy without adverse pregnancy history,the incidence of adverse pregnancy outcomes and complications of RSA patients with ANA-positive is still higher after treatment with progesterone alone,which should be detected as soon as possible and timely intervention for such patients. |
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