低分子肝素在妊娠期高血压疾病中的应用：疗效、作用机制与临床价值

Application of Low Molecular Weight Heparin in Hypertensive Disorders of Pregnancy: Efficacy, Mechanisms, and Clinical Value

摘要: 妊娠期高血压疾病(HDP)，包括妊娠期高血压、子痫前期及重度子痫前期，是威胁孕产妇及围产儿生命安全的主要原因之一。其病理生理机制复杂，涉及血管痉挛、内皮损伤、凝血–抗凝系统失衡及炎症反应等。低分子肝素(LMWH)作为一种经典的抗凝药物，因其抗凝、抗炎、改善内皮功能及调节免疫等多重药理作用，在HDP的治疗与预防中展现出潜力。本文基于近年来的临床研究与机制探索，综述LMWH联合不同降压方案(如拉贝洛尔、硝苯地平、硫酸镁)在HDP中的疗效、对凝血功能、血管内皮功能、氧化应激及妊娠结局的影响，并探讨其可能的作用靶点，以期为临床实践提供参考。

Abstract: Hypertensive disorders of pregnancy (HDP), including gestational hypertension, preeclampsia, and severe preeclampsia, are major causes of maternal and perinatal morbidity and mortality worldwide. The pathophysiology is complex, involving vasospasm, endothelial injury, coagulation-anticoagulation imbalance, and inflammatory responses. Low molecular weight heparin (LMWH), a classic anticoagulant, has shown potential in the treatment and prevention of HDP due to its multiple pharmacological effects, including anticoagulation, anti-inflammation, endothelial function improvement, and immune modulation. Based on recent clinical studies and mechanistic explorations, this article reviews the efficacy of LMWH combined with different antihypertensive regimens (e.g., labetalol, nifedipine, magnesium sulfate) in HDP, its effects on coagulation function, vascular endothelial function, oxidative stress, and pregnancy outcomes, and discusses its possible therapeutic targets, aiming to provide a reference for clinical practice.