补肾调冲安胎方治疗复发性流产疗效及对患者子宫内膜容受性和妊娠结局的影响

Effect of Bushen Tiaochong Antai decoction on recurrent abortion and its impact on endometrial receptivity and pregnancy outcome

目的观察补肾调冲安胎方治疗复发性流产的临床疗效及对患者子宫内膜容受性和妊娠结局的影响。方法将辽宁省人民医院2017年6月—2018年6月收治的84例复发性流产患者随机分为2组,对照组给予主动免疫治疗,每3周治疗1次,4次为1个疗程,妊娠成功后继续治疗至妊娠12周;观察组在对照组治疗基础上给予补肾调冲安胎方治疗,以12周为1个疗程,连续用药至妊娠超过既往流产的最长月份2周后。比较2组治疗1个疗程后中医症状积分(头晕耳鸣、腰酸腹痛、夜尿频多、情志异常、失眠乏力)、子宫内膜容受性[子宫内膜厚度、子宫内膜下动脉血流阻力指数(RI)和搏动指数(PI)]、血清性激素水平[血清绒毛膜促性腺激素(HCG)、孕酮(P)、雌二醇(E 2)],统计2组不良反应发生情况,随访2组妊娠结局。结果与治疗前比较,2组治疗后头晕耳鸣、腰酸腹痛、夜尿频多、情志异常、失眠乏力积分及RI、PI均明显降低(P均<0.05),2组治疗后子宫内膜厚度及血清HCG、P、E 2水平均明显升高(P均<0.05);与对照组比较,观察组治疗后上述各指标改善情况均明显优于对照组(P均<0.05);2组治疗期间均未出现明显不良反应。随访中,观察组活产率为90.5%(38/42),明显高于对照组的71.4%(30/42)(x^2=4.941,P<0.05)。结论补肾调冲安胎方联合主动免疫治疗能够提高复发性流产患者血清雌孕激素水平和子宫内膜容受性,改善妊娠结局。

Objective It is to observe the clinical efficacy of Bushen Tiaochong Antai decoction in the treatment of recurrent abortion and its effect on endometrial receptivity and pregnancy outcome.Methods Eighty-four patients with recurrent miscarriage treated in Liaoning Provincial People’s Hospital from June 2017 to June 2018 were randomly divided into two groups.The control group was given active immunotherapy,once every 3 weeks and 4 times as a course of treatment.After successful pregnancy,the treatment was continued to 12 weeks of pregnancy.The observation group was treated with Bushen Tiaochong Antai decoction based on the control group,12 weeks as a course of treatment,the continuous medication was not stopped until 2 weeks after the longest month of pregnancy exceeding the previous abortion.The TCM syndrome scores(dizziness,tinnitus,backache,abdominal pain,frequent nocturia,abnormal mood,insomnia and fatigue),endometrial receptivity[endometrial thickness,subendometrial arterial blood flow resistance index(RI)and pulsatility index(PI)],serum estrogen and progesterone levels[serum chorionic gonadotropin(HCG),progesterone(P),estradiol(E 2)]after 1 course of treatment were compared in the two groups,the occurrence of adverse reactions were counted,the outcome of pregnancy in both groups were followed up.Results Compared with before treatment,the scores of dizziness,tinnitus,backache,abdominal pain,frequent nocturia,abnormal mood,insomnia and fatigue,RI and PI were significantly reduced in the two groups after treatment(P<0.05),endometrial thickness and serum levels of HCG,P,and E 2 was significantly increased(P<0.05).The improvement of the above indicators in the observation group was significantly better than that in the control group(P<0.05);no obvious adverse reactions was found in the two groups during the treatment period.During the follow-up,the live birth rate in the observation group was 90.5%(38/42),which was significantly higher than 71.4%(30/42)in the control group(x^2=4.941,P<0.05).Conclusion Bushen Tiaochong Antai decoction combined with active immunotherapy can increase serum estrogen and progesterone levels and endometrial receptivity and improve pregnancy outcomes in patients with recurrent abortion.