滋肾活血安胎汤在肾虚血瘀型复发性流产治疗中的应用价值及机制研究

Study on Application Value and Mechanism of Zishen Huoxue Antai Decoction in Treatment of Recurrent Abortion with Kidney Deficiency and Blood Stasis

目的评价滋肾活血安胎汤在肾虚血瘀型复发性流产患者治疗中的应用价值及机制研究。方法选择2017年1月—2019年11月医院住院部收治复发性流产患者120例,依据随机对照法将患者分为治疗组和对照组,每组60例。对照组按照常规先兆流产保胎处理,口服地屈孕酮片10 mg,2次/d,维生素E胶丸100 mg,口服,3次/d。根据自身免疫情况酌情加用低分子肝素治疗。治疗组在对照组治疗的基础上,口服滋肾活血安胎汤治疗。15 d为1个疗程,连用3个疗程,根据患者病情必要时可用至孕28周。比较两组治疗前后中医症候积分、治疗疗效,比较治疗前后性激素水平、比较治疗前后两组患者ACA阳性率,比较两组妊娠结局。结果治疗组治疗总有效率为91.67%(55/60)高于对照组治疗总有效率的78.33%(47/60)(P<0.05);治疗组治疗后阴道流血时间、阴道流血量、阴道流血色质、腰膝酸软和下腹坠胀等中医症候积分低于对照组(P<0.05);治疗组治疗后E2、P和HCG水平高于对照组(P<0.05);治疗组治疗后ACA阳性率较治疗前降低,且低于同期对照组(P<0.05)。对照组治疗前后ACA阳性率比较差异无统计学意义(P>0.05);治疗组患者妊娠成功率高于对照组(P<0.05)。结论补肾活血汤结合地屈孕酮治疗先兆流产疗效确切,可有效的改善患者的临床症状,提高性激素水平,改善胎儿生长环境,改善妊娠结局,保胎效果好。

Objective To evaluate the value and mechanism of Zishen Huoxue Antai Decoction in the treatment of recurrent abortion with kidney deficiency and blood stasis. Methods A total of 120 patients with recurrent abortion admitted to the inpatient department of our hospital from January 2017 to November 2019 were selected, and the patients were divided into experimental group and control group according to the randomized control method, with 60 cases in each group. The control group was treated according to the routine treatment of threatened abortion to preserve the fetus,Diquprogesterone Tablets 10 mg twice a day and Vitamin E Capsules 100 mg orally three times a day. Low molecular weight heparin(LMWH) was given according to the situation of autoimmune condition. The experimental groupon the basis of treatment in the control group, added Zishen Huoxue Antai Decoction. Fifteen days was a course of treatment, totally 3 courses of treatment.According to the patients’ condition,it can be up to 28 weeks of pregnancy if necessary. TCM syndrome score,therapeutic effect and ACA positive ratesbefore and after treatment were compared. And pregnancy outcomes of the two groups were compared. Results The total effective rate of the experimental group was 91.67%(55/60),higher than that of the control group(78.33%,47/60)(P<0.05). After treatment, the scores of TCM symptoms such as vaginal bleeding time, vaginal bleeding volume, vaginal bleeding color, lumbar and knee tenderness and abdominal distension in the experimental group were lower than those in the control group(P<0.05). The levels of E2, P and HCG in the experimental group were higher than those in the control group(P<0.05). The ACA positive rate in the experimental group was lower than that in the control group(P<0.05). There was no significant difference in ACA positive rate before and after treatment in the control group(P>0.05).The pregnancy success rate of the experimental group was higher than that of the control group(P<0.05). Conclusion Zishen Huoxue Antai Decoction combined with diquprogesterone is effective in the treatment of threatened abortion, which can effectively improve the clinical symptoms of patients, increase the levels of sex hormones, improve the fetal growth environment and the outcome of pregnancy, and have a good effect on fetus preservation.