止血灸联合补肾安胎方对早期先兆流产合并绒毛膜下血肿患者免疫因子及妊娠结局的影响

Effectof Hemostatic Moxibustion Combined with Kidney Tonifying and Fetal Safety Prescription on Immune Factors and Pregnancy Outcomes for Female Patients with Early Threatened Abortion and Subchorionic Hematoma

目的:探讨止血灸联合补肾安胎方治疗早期先兆流产合并绒毛膜下血肿的临床疗效观察。方法:将86例患者分为三组,A组30例,采用常规保胎治疗(黄体酮注射液20-60mg/次,肌肉注射+达芙通10mg/片,1片Tid)。B组26例,常规保胎治疗+补肾安胎方。C组30例,常规保胎治疗+补肾安胎方+止血灸,连续治疗3周,分别于治疗前及治疗结束后,检查血清细胞因子(INF-y、IL-10、)及免疫因子(Th1、Th2、Th1/Th2、NK);采用B超于治前、治疗10天、20天分别测绒毛膜下血肿面积;比较三组临床疗效并追踪妊娠结局。结果:(1)从妊娠结局来看,通过流产率、早产率、足月产率、活产率比较,看到C组在流产率、早产率均低于A、B组,在足月产率、活产率上高于A、B组;且在分娩孕周上,C组较A、B组能提高分娩孕周;(2)从绒毛膜下血肿面积及比值看,C组在治疗10天、20天后均低于A、B组,且与A组比较P<0.01有显著统计学意义;(3)从细胞因子情况看,C组在治疗结束后与A、B组比较,能有效的降低INF-y、NK%,提高IL-10,与A、B组比较(P<0.01,P<0.05)有统计学意义;各组与本组治疗前比较,均能降低INF-y、NK%,提高IL-10,有统计学意义(P<0.01,P<0.05);(4)从免疫因子情况看,C组在治疗结束后与A、B组比较,能有效的提高Th2%、Th1/Th2,与A、B组比较P<0.05,有统计学意义;各组与本组治疗前比较,均能降低Th1%,提高Th1/Th2有统计学意义(P<0.01,P<0.05)结论:止血灸联合补肾安胎方能通过调节免疫因子,改善细胞免疫调节,从而促进绒毛膜下血肿吸收,能有效改善早期妊娠先兆流产合并绒毛膜下血肿患者妊娠结局,提高了分娩孕周、足月产率、活产率,降低了流产率、早产率。

Objective:To investigate the clinical effect of applying hemostasis moxibustion combined with Kidney Tonifying and Fetal Safety Prescription in the treatment of early threatened abortion combined with hematoma.Methods:86 cases were divided into three groups,30 cases in a group A were treated with routine fetal protection(Progesterone Injection 20~60 mg/time,Intramuscular Injection and Daputone 10 mg/tablet,1 tablet,Tid).In a group B,26 cases were treated with routine fetal protection and Kidney Tonifying and Fetal Safety Prescription.30 cases in a group C were treated with routine fetal protection,Kidney Tonifying and Fetal Safety Prescription and hemostatic moxibustion for 3 weeks.Before and after treatment,the changes of serum cytokines(INF-γ,IL-10,)and immune factors(Th1,Th2,Th1/Th2,NK)were examined.The area of chorionic hematoma was measured before treatment,10 and 20 days by B-ultrasound.The clinical effects of the three groups were compared and the pregnancy outcome was tracked.Results:(1)From the perspective of pregnancy outcome,through the comparison of abortion rate,preterm delivery rate,full-term delivery rate and live delivery rate,it was found that the abortion rate and premature delivery rate of the group C was lower than those of the group A and B,and the full-term delivery rate and live delivery rate were higher than those of the group A and B;and in the gestational weeks of delivery,the group C could improve the gestational weeks of delivery compared with the group A and B;(2)From the area and ratio of subchorionic hematoma,the group C was lower than that of the group A after 10 and 20 days of treatment compared with the group A and B,P<0.01,P<0.05;(3)Compared with the group A,B and C could effectively reduce INF-γand NK,and increase IL-10,which was statistically significant compared with group A and group B(P<0.01,P<0.05);compared with group A and group B,group C can reduce inf-y and NK,and increased IL-10,which was statistically significant(P<0.01,P<0.05);(4)From the perspective of immune factors,the group C and the group A after treatment compared with the group A and the group B,it can effectively improve Th2%,Th1/Th2,P<0.05,which was statistically significant;compared with the group A and the group B,each group can reduce Th1%,and increased Th1/Th2,which was statistically significant(P<0.01,P<0.05).Conclusion:Hemostasis moxibustion combined with Kidney Tonifying and Fetal Safety Prescription can improve cellular immune regulation through regulating immune factors,thus promote the absorption of subchorionic hematoma,and can effectively improve the pregnancy outcome of the patients with early pregnancy threatened abortion combined with chorionic hematoma,can improve the pregnant week,full-term rate and live rate,and reduce the abortion rate and premature delivery rate.