低分子量肝素在复发性流产治疗中的研究进展及争议

Low Molecular Weight Heparin in the Treatment of Recurrent Spontaneous Abortion: Advances and Controversies

关键词:  低分子量肝素  复发性流产  抗凝治疗  免疫调节  胎盘功能

Key words:  low molecular weight heparin  recurrent spontaneous abortion  anticoagulation therapy  immunomodulation  placental function

摘要:

摘要：目的 系统综述低分子量肝素(LMWH)在复发性流产(RSA)治疗中的作用机制、临床应用及国际指南推荐的研究进展及争议。方法 通过系统检索和分析国内外相关文献，从抗凝、抗炎、免疫调节和改善胎盘功能等方面总结LMWH的作用机制，并对其在不同类型RSA中的临床应用效果进行评价。结果 LMWH通过多靶点药理效应在RSA治疗中发挥作用，在血栓前状态和抗磷脂综合征相关RSA中疗效确切，但在不明原因RSA中的治疗价值仍需更多高质量研究证实。结论 LMWH在特定类型RSA治疗中具有重要价值，未来研究应聚焦于个体化治疗方案优化和非抗凝作用机制的深入探索。

Abstract:

ABSTRACT: OBJECTIVE To systematically review the research progress and controversies regarding the mechanisms of action, clinical applications, and international guideline recommendations of low molecular weight heparin (LMWH) in the treatment of recurrent spontaneous abortion (RSA). METHODS Relevant domestic and international literature was systematically retrieved and analyzed to summarize the mechanisms of LMWH from the perspectives of anticoagulation, anti-inflammation, immunomodulation, and improvement of placental function, and to evaluate its clinical efficacy in different types of RSA. RESULTS LMWH exerts therapeutic effects in RSA through multiple pharmacological targets. It demonstrates confirmed efficacy in RSA cases associated with prethrombotic state and antiphospholipid syndrome, but its value in unexplained RSA requires further validation through high-quality studies. CONCLUSION LMWH plays an important role in the treatment of specific types of RSA. Future research should focus on optimizing individualized treatment regimens and further exploring its non-anticoagulant mechanisms.