低剂量阿司匹林对遗传性易栓症患者子宫血流灌注的改善作用

doi:10.3969/j.issn.1674-8115.2026.02.008

摘要/Abstract

摘要：

目的·利用子宫彩色多普勒超声血流参数检测，评估遗传性易栓症（thrombophilia）即遗传性血栓前状态（prethrombotic state，PTS）患者的子宫内膜容受性，并探讨低剂量阿司匹林（low-dose aspirin，LDA）的治疗效果。方法·选择2023年1月至2024年12月期间，因不孕或不良妊娠史于上海交通大学医学院附属仁济医院妇产科就诊的患者265例为研究对象。经过纳入、排除标准筛选，共计191例患者入组。依据《复发性流产病因检查专家共识》2022版，将入组患者分为遗传性PTS组（n=71）、抗磷脂综合征（antiphospholipid syndrome，APS）组（n=70）和对照组（n=50）；其中遗传性PTS组、APS组患者给予LDA行为期2个月的连续治疗，对照组患者不接受LDA治疗。主要观察指标为子宫动脉血流参数［包括搏动指数（pulsatility index，PI）、阻力指数（resistance index，RI）、收缩/舒张比（systolic/diastolic ratio，S/D）］和子宫内膜参数［包括子宫内膜厚度、子宫内膜血流参数（PI、RI、S/D）］。于LDA治疗前，采用彩色多普勒超声对3组患者的主要观察指标进行检测；待遗传性PTS组、APS组患者完成LDA治疗后行第二次检测。比较3组患者在治疗前的超声参数，分析遗传性PTS对子宫内膜厚度及血流灌注的影响。比较遗传性PTS组与APS组患者在治疗前后的超声参数，评估LDA的治疗效果。结果·LDA治疗前，与对照组相比，APS组和遗传性PTS组患者的子宫内膜血流参数（PI、RI、S/D）及子宫动脉血流参数（RI、S/D）均处于较高水平（P<0.05）。LDA治疗后，遗传性PTS组患者的子宫内膜血流PI以及子宫动脉血流PI、RI、S/D均较治疗前有所下降（P<0.05）。结论·遗传性PTS患者存在子宫内膜灌注不良，LDA治疗可显著改善遗传性PTS患者的子宫内膜血流及子宫动脉灌注，这对提高其内膜容受性具有潜在临床价值。

关键词: 遗传性易栓症, 彩色多普勒超声血流参数, 子宫动脉, 子宫内膜血流, 低剂量阿司匹林

Abstract:

Objective ·To evaluate endometrial receptivity in patients with hereditary thrombophilia [i.e., hereditary prethrombotic state (PTS)] and explore the therapeutic effect of low-dose aspirin (LDA) using uterine color Doppler ultrasound blood flow parameter detection. Methods ·A total of 265 patients who attended the Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2023 to December 2024 due to infertility or a history of adverse pregnancy outcomes were enrolled as research subjects. Based on the inclusion and exclusion criteria, 191 patients were finally included in the study. According to the Expert Consensus on the Diagnosis of Causes of Recurrent Miscarriage (2022 edition), the patients were divided into three groups: the hereditary PTS group (n=71), the antiphospholipid syndrome (APS) group (n=70), and the control group (n=50). Patients in the hereditary PTS and APS groups were treated with LDA continuously for 2 months, while the control group did not receive LDA treatment. The main observation indicators included uterine artery blood flow parameters [pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio (S/D)] and endometrial parameters [endometrial thickness and endometrial blood flow parameters (PI, RI, and S/D). Before LDA treatment, color Doppler ultrasound was used to detect the main observation indicators in the three groups of patients. After completing LDA treatment, patients in the hereditary PTS and APS groups underwent a second measurement. The ultrasonographic parameters of the three groups before treatment were compared to analyze the effects of hereditary PTS on endometrial thickness and blood perfusion. In addition, the ultrasonographic parameters of the hereditary PTS group and APS group before and after treatment were compared to evaluate the therapeutic efficacy of LDA. Results ·Before LDA treatment, compared with the control group, patients in the APS group and hereditary PTS group exhibited higher levels of endometrial blood flow parameters (PI, RI, S/D) and uterine artery blood flow parameters (RI, S/D) (P<0.05). After LDA treatment, patients in the hereditary PTS group showed decreases in endometrial blood flow PI, as well as uterine artery blood flow PI, RI, and S/D (P<0.05). Conclusion ·Patients with hereditary PTS have endometrial hypoperfusion, and LDA treatment can significantly improve endometrial blood flow and uterine artery perfusion in these patients, which has potential clinical value in enhancing their endometrial receptivity.

Key words: hereditary thrombophilia, color Doppler ultrasound blood flow parameter, uterine artery, endometrial blood flow, low-dose aspirin (LDA)

中图分类号:

R714.2

曹轶磊, 刘维纯, 张晓欣, 赵爱民. 低剂量阿司匹林对遗传性易栓症患者子宫血流灌注的改善作用[J]. 上海交通大学学报（医学版）, 2026, 46(2): 200-205.

Cao Yilei, Liu Weichun, Zhang Xiaoxin, Zhao Aimin. Effect of low-dose aspirin on uterine blood perfusion in patients with hereditary thrombophilia[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(2): 200-205.

图/表 4

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Item	PTS group (n=71)	APS group (n=70)	Control group (n=50)	P value
Age/year	31 (29, 33)	31 (29, 33)	31 (29, 33)	0.926
Previous miscarriages/n	1 (1, 2)	2 (1, 3)	0 (0, 1)	<0.001
BMI/(kg·m^-²)	21.47 (19.42, 23.91)	22.77 (20.37, 24.34)	22.72 (21.06, 24.28)	0.244

Item	PTS group (n=71)	APS group (n=70)	Control group (n=50)	P value
Age/year	31 (29, 33)	31 (29, 33)	31 (29, 33)	0.926
Previous miscarriages/n	1 (1, 2)	2 (1, 3)	0 (0, 1)	<0.001
BMI/(kg·m^-²)	21.47 (19.42, 23.91)	22.77 (20.37, 24.34)	22.72 (21.06, 24.28)	0.244

Item	PTS group (n=71)	APS group (n=70)	Control group (n=50)	P value
Endometrium
Endometrial thickness/mm	8.70 (7.50, 9.80)	8.50 (7.12, 9.67)	9.65 (8.50, 10.28)	0.053
PI	1.13 (1.03, 1.25)	1.12 (0.90, 1.27)	0.83 (0.74, 1.01)	<0.001
RI	0.60 (0.59, 0.62)	0.60 (0.58, 0.62)	0.50 (0.45, 0.54)	<0.001
S/D	2.50 (2.42, 2.60)	2.50 (2.37, 2.60)	2.00 (1.82, 2.19)	<0.001
Uterine Artery
mPI	2.21 (2.04, 2.46)	2.04 (1.70, 2.39)	1.98 (1.73, 2.28)	0.189
mRI	0.83 (0.83, 0.85)	0.83 (0.81, 0.84)	0.80 (0.76, 0.81)	<0.001
mS/D	6.12 (5.91, 6.58)	5.93 (5.37, 6.50)	4.96 (4.21, 5.22)	0.002

Item	PTS group (n=71)	APS group (n=70)	Control group (n=50)	P value
Endometrium
Endometrial thickness/mm	8.70 (7.50, 9.80)	8.50 (7.12, 9.67)	9.65 (8.50, 10.28)	0.053
PI	1.13 (1.03, 1.25)	1.12 (0.90, 1.27)	0.83 (0.74, 1.01)	<0.001
RI	0.60 (0.59, 0.62)	0.60 (0.58, 0.62)	0.50 (0.45, 0.54)	<0.001
S/D	2.50 (2.42, 2.60)	2.50 (2.37, 2.60)	2.00 (1.82, 2.19)	<0.001
Uterine Artery
mPI	2.21 (2.04, 2.46)	2.04 (1.70, 2.39)	1.98 (1.73, 2.28)	0.189
mRI	0.83 (0.83, 0.85)	0.83 (0.81, 0.84)	0.80 (0.76, 0.81)	<0.001
mS/D	6.12 (5.91, 6.58)	5.93 (5.37, 6.50)	4.96 (4.21, 5.22)	0.002

Item	Before LDA treatment	After LDA treatment	P value
Endometrium
Endometrial thickness/mm	8.70 (7.50, 9.80)	8.60 (7.70, 10.30)	0.705
PI	1.12±0.18	1.08±0.16	0.036
RI	0.60 (0.59, 0.62)	0.60 (0.58, 0.61)	0.100
S/D	2.50 (2.42, 2.60)	2.49 (2.38, 2.50)	0.110
Uterine Artery
mPI	2.21 (2.04, 2.46)	1.36 (1.22, 1.46)	<0.001
mRI	0.83±0.04	0.79±0.05	0.001
mS/D	6.05±0.94	4.74±0.70	0.001