补肾活血方联合地屈孕酮对复发性自然流产患者CD4^+CD25^+调节性T细胞及IL-10、TGF-β1表达的影响

Effect of Expression of CD4^+CD25^+ regulatory T cells and IL- 10 and TGF- β1 in Recurtrent spontaneous abortion Patients by Combined Use of Bushen Huoxue Decoction and Dydrogesterone

目的:探讨补肾活血方联合地屈孕酮治疗复发性自然流产(RSA)的疗效及免疫调节机制。方法:选择肾虚血瘀型RSA妊娠患者62例,随机分为中药组(21例)、西药组(20例)、中西药组(21例)。中药组采用自拟补肾活血方治疗,西药组采用地屈孕酮治疗,中西药组采用两者联合治疗。同时选正常妊娠者20例为正常对照组,不予任何药物治疗。观察各组治疗前后临床疗效、流式细胞仪测定外周血CD4+CD25+调节性T细胞百分率,ELISA法检测血清IL-10、TGF-β1水平。结果:中西药组临床综合疗效优于其余两组,但差异无统计学意义(P>0.05),中药组和西药组疗效比较,差异亦无统计学意义(P>0.05)。治疗组各组治疗后较治疗前外周血CD4+CD25+调节性T细胞百分率、血清IL-10及TGF-β1水平均明显升高(P<0.05)。治疗后与中药组、西药组相比,中西药组外周血CD4+CD25+调节性T细胞百分率、血清IL-10及TGF-β1水平升高(P<0.05),中药组与西药组间比较,则均无统计学意义(P>0.05)。结论:补肾活血方联合地屈孕酮治疗肾虚血瘀型RSA临床疗效确切,从整体上调节免疫耐受状态,使妊娠得以维持。

Objective： To investigate the effect of Bushen Huoxue decoction combined with Dydrogesterone on recurrent spontaneous abortion（ RSA） and study its immunoregulatory mechanism. Methods： 62 cases of the pregnant patients with RSA of kidney deficiency and blood stasis were allocated into TCMG（ traditional Chinese medicine group）,WMG（ western medicine group） and CTWG（ combination of traditional Chinese and western medicine group）. The TCMG was treated with Bushen Huoxue Decoction. The WMG was treated by Dydrogesterone Tablets and the CTWG was given both. Meanwhile,20 normal pregnancies were treated as control group with no drug treatment. We observed the clinical effect,the proportions of CD4^＋CD25^＋regulatory T cells in peripheral blood and the serum levels of IL- 10 and TGF- β1 were detected pre- therapy and post- treatment by flow cytometric analysis and ELISA respectively. Results： After treatment,comparing the clinical comprehensive effect,the CTWG was better than that in TCMG and WMG but there was no significant difference（ P 〉0. 05）. Moreover,compared with WMG,the clinical comprehensive effect was not significantly increased in TCMG（ P 〉0. 05）. After treatment,the proportions of CD4^＋CD25^＋regulatory T cells in peripheral blood and the serum levels of IL- 10 and TGF- β1 in each treatment group were significantly higher than those before（ P 〈0. 05）.After treatment,compared with the TCMG and WMG,the proportions of CD4^＋CD25^＋regulatory T cells in peripheral blood and the serum levels of IL- 10 and TGF- β1 were higher in CTWG（ P〈 0. 05）. Whereas,in that regard there was no significant difference between the TCMG and WMG（ P〉 0. 05）. Conclusion： Bushen Huoxue Decoction combined with Dydrogesterone has curative effect on therapy of RSA. It can validly regulate the immune tolerance so as to maintain a pregnancy status.