| Objective:Based on the combination of patients with systemic lupus erythematosus pregnancy coagulation and fibrinolytic related monitoring data,to explore the changes of coagulation function in patients with systemic lupus erythematosus complicated by pregnancy,pregnancy outcome,changes of coagulation function contrast anticoagulant therapy and non anticoagulant therapy,evaluation of anticoagulant therapy.Methods:This study collected 160 cases of pregnancy between 28 and 41 weeks of pregnancy from January 1,2010 to December 31,2017 in General Hospital Affiliated to Tianjin Medical University,including 104 cases of pregnancy with SLE patients and 56 cases of normal pregnancy without amalgamative women.All of them have complete clinical data.The relationship between D-dimer,FIB and PT test results,adverse pregnancy outcomes and anticoagulant treatment was statistically analyzed by retrospective analysis.According to the pregnancy week,35 cases of pregnancy(28~37 weeks)were divided into 7 cases of normal pregnancy(group A)and 28 cases of group SLE(group B),and 125 cases of late pregnancy(37~40 weeks)were divided into 49 normal pregnancy group(C group)and 76 pregnant SLE group(D group).According to the type of drug use,104 patients with SLE were divided into 2 groups: 18 cases of anticoagulant group(group E)and 86 non anticoagulant group(group F)with aspirin and / or low molecular weight heparin for anticoagulation group(group E)and non anticoagulant drugs.56 cases of untreated normal pregnancy were group G.According to whether SLE is active,104 patients with SLE were divided into 66 groups(group G)and 38 cases of activity group(group H).Data statistics and analysis are carried out by SPSS19.0 software.Results:(1)D-dimer in 56 normal pregnant women was significantly higher than that in non pregnant women,and increased with the increase of gestational age.The increase of D-dimer in each stage was statistically significant compared with the previous stage(P < 0.05).(2)In 7 pregnant women with SLE with complete D-dimer data,D-dimer increased with the increase of gestational age,reaching the peak in the third trimester.And the D-dimer rise at each stage was statistically significant compared with the previous stage(P < 0.05).(3)In the mid-term pregnancy group,the normal pregnancy(group A)and the pregnancy combined with SLE(group B)were compared: the level of FIB and D-dimer in the group SLE was higher than that in the normal pregnancy group;the PT level was lower than that of the normal pregnancy group,the difference was statistically significant(P < 0.05).In the late pregnancy group,normal pregnancy(group C)and pregnancy combined with SLE(group D)were compared: the level of FIB and D-dimer in group SLE was higher than that of normal pregnancy group,the difference was statistically significant(P < 0.05);PT level was lower than that of normal pregnancy group,the difference was not statistically significant(P > 0.05).(4)Compared with the non anticoagulant group(group F)of SLE patients(group E),the incidence of FGR and premature delivery in group E was significantly lower than that in group F(P<0.05),and the incidence of fetal distress and pregnancy induced hypertension(PIH)and postpartum hemorrhagewas similar,and the difference was not statistically significant(P>0.05).(5)Compared with the non anticoagulant group,FIB,D-dimer and PT in the SLE anticoagulant group were similar to those in the non anticoagulant group,and the difference was not statistically significant(P > 0.05).Compared with non anticoagulant group,FIB,D-dimer and PT in anticoagulant group were all close to non anticoagulant group in SLE full-term delivery group(P > 0.05).(6)The level of FIB and D-dimer in the stable group(group G)was compared with that of the SLE group(group H).The level of FIB and D-dimer in the stable group was lower than that of the active group(P < 0.05).The level of PT was higher than that of the active group(P < 0.05),and the difference was statistically significant(P <0.05).Conclusion:(1)Compared with healthy pregnant women,the blood of normal pregnant women is hypercoagulable,and the trend increases with the increase of gestational weeks,which is a physiological phenomenon.(2)In pregnancy with SLE,blood is hypercoagulable,which is more obvious than physiological hypercoagulability in normal pregnancy.(3)There are often many adverse pregnancy outcomes in pregnant women with SLE,which is related to the imbalance of coagulation fibrinolytic system and hypercoagulability in vivo.Even in stable SLE patients,hypercoagulable state was significantly increased compared with normal pregnancy.(4)SLE patients need to choose the right time to conceive.Under the combined treatment of Obstetrics and Department of rheumatism,intensive care during pregnancy,the application of anticoagulants such as low molecular weight heparin and aspirin can help to reduce the disease activity during pregnancy,reduce the risk of complications,improve the survival rate and improve the pregnancy outcome.(5)There is no unified standard of anticoagulant therapy for SLE patients.In high-risk pregnant women,whether the use of anticoagulant drugs is adjusted according to the detection index of pregnancy,and the reference range should be further studied. |
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