益肾化瘀方治疗不明原因复发性流产的临床研究

Clinical Study on Yishen Huayu Formular Treating Unexplained Recurrent Spontaneous Abortion

目的观察中药益肾化瘀方治疗不明原因复发性流产患者的临床疗效,及对血清D-二聚体水平、血小板聚集率(PAR)、子宫动脉阻力指数(RI)及妊娠结局的影响。方法入组82例不明原因复发性流产患者,随机分为对照组41例和治疗组41例。对照组采用皮下注射低分子肝素钠联合口服阿司匹林治疗,治疗组在对照组基础上加服益肾化瘀方,观察2组患者治疗前后中医证候积分的变化,血浆D二聚体水平、PAR、RI的变化,孕4周和孕8周的血清βHCG水平及妊娠结局。结果治疗后治疗组临床有效率高于对照组,差异有统计学意义(P<0.05);中医证候积分较治疗前均下降(P<0.05~0.01),治疗组优于对照组(P<0.05):2组患者治疗后PAR、RI、孕8周血清β-HCG水平差异有统计学意义(P<0.05);D-二聚体水平、孕4周血清β-HCG水平比较差异无统计学意义(P>0.05);治疗组继续妊娠率高于对照组(P<0.05)。结论益肾化瘀方联合西药能降低不明原因复发性流产患者的D二聚体水平、PAR、RI,改善胎盘血流灌注,从而提高再次妊娠率。

OBJECTIVE To observe the clinical efficacy of treating unexplained recurrent spontaneous abortion with Yishen Huayu formular and its influence on serum D-dimer level,platelet aggregation rate(PAR),resistant index of uterus artery(RI)and pregnancy outcome.METHODS 82 patients with unexplained recurrent spontaneous abortion were randomly divided into two groups:the control group(41 patients)and the treatment group(41 patients).The control group was given subcutaneous injection of low molecular weight heparin sodium combined with aspirin taken orally.The treatment group was given Yishen Huayu formular based on medications given to the control group.Changes of TCM symptom scores,serum D-dimer level,platelet aggregation rate(PAR),resistant index of uterus artery(RI),serumβ-HCG level at four and eight gestational weeks and pregnancy outcome in two groups before and after treatment were observed.RESULTS After treatment,clinical effective rate of the treatment group was higher than that of the control group and the differences were statistically significant(P<0.05).TCM syndrome score decreased after treatment in two groups(P<0.01),and the treatment group was better(P<0.05).The differences of PAR,RI,serumβ-HCG level at eight gestational weeks in two groups were statistically significant(P<0.05)while there was no statistical significance between two groups in terms of D-dimer level and serumβ-HCG level at four gestational weeks(P>0.05).Pregnancy rate of the treatment group were higher than that of the control group(P<0.05).CONCLUSION Yishen Huayu formular combined with western medicine can decrease unexplained recurrent spontaneous abortion patients'D-dimer level,PAR,and RI,and improve uteroplacental blood perfusion,leading to increasing the repregnant rate.