补肾养血安胎方联合低分子肝素、地屈孕酮对先兆流产合并宫腔血肿患者妊娠结局的影响

Influence of Bushen Yangxue Antai Decoction Combined with Low Molecular Weight Heparin and Dydrogesterone on Pregnancy Outcome of Threatened Abortion Patients with Intrauterine Hematoma

目的观察补肾养血安胎方联合低分子肝素、地屈孕酮对先兆流产合并宫腔血肿(IUH)患者妊娠结局的影响。方法采用随机平行对照研究,将112例早期先兆流产合并IUH患者分为两组。对照组(56例)采用低分子肝素和地屈孕酮治疗,观察组(56例)在对照组基础上加用补肾养血安胎方治疗。比较两组近期疗效、中医证候积分及妊娠结局,治疗前及治疗后检测内分泌激素[雌二醇(E2)、孕酮(P)、β-人绒毛膜促性腺激素(β-HCG)]、炎症因子[干扰素-γ(INF-γ)、肿瘤坏死因子-α(TNF-α)、白介素-4(IL-4)、白介素-10(IL-10)]、凝血-纤溶指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(TT)、纤维蛋白原(FIB)、D-二聚体(DD)、纤溶酶原激活物抑制剂-1(PAI-1)和组织型纤溶酶原活化剂(t-PA)],超声检测血肿面积、子宫螺旋动脉收缩期峰值血流速度(PSV)、舒张期末血流速度(EDV)和阻力指数(RI)。结果治疗后观察组和对照组总有效率比较,差异无统计学意义(P>0.05),但观察组愈显率显著高于对照组,且治疗后中医证候积分显著低于对照组(P<0.05)。治疗后,两组内分泌激素E2、P、β-HCG均较本组治疗前显著升高,且观察组显著高于对照组(P<0.05);两组治疗后炎症因子IL-4、IL-10较本组治疗前升高,TNF-α、INF-γ和INF-γ/IL-4比值较本组治疗前降低;凝血-纤溶指标APTT、PT较本组治疗前延长,D-D和FIB较本组治疗前降低;血肿面积、子宫螺旋动脉RI均较本组治疗前降低,子宫螺旋动脉PSV和EDV较本组治疗前升高,且上述指标治疗后组间比较差异均有统计学意义(P<0.05)。观察组足月妊娠率和保胎成功率显著高于对照组(P<0.05),妊娠期高血压综合征(PIH)发生率显著低于对照组(P<0.05)。结论补肾养血安胎方联合低分子肝素、地屈孕酮能够改善先兆流产合并IUH患者的临床症状,调节性激素水平及免疫-内分泌平衡,改善子宫胎盘灌注状态和血栓前状态,改善妊娠结局。

Objective To observe the effect of Bushen Yangxue Antai Decoction combined with low molecular weight heparin and dydrogesterone on the pregnancy outcome of threatened abortion patients with intrauterine hematoma(IUH).Methods Using random parallel control,112 early threatened abortion patients with IUH were divided into 2 groups:the control group(n=56)was treated with low molecular weight heparin and dydrogesterone,the observation group(n=56)received Bushen Yangxue Antai Decoction treatment on the basis of the control group.The short-term efficacy,TCM syndrome scores and pregnancy outcome of two groups were compared.Endocrine hormones[estradiol(E2),progesterone(P),β-human chorionic gonadotropin(β-HCG)]were tested before and after treatment.,Inflammatory factors[Interferon-γ(INF-γ),tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),interleukin-10(IL-10)],coagulation-fibrinolysis index[Activated partial thromboplastin time(APTT),prothrombin time(TT),fibrinogen(FIB),D-dimer(DD),plasminogen activator inhibitor-1(PAI-1)and Tissue plasminogen activator(t-PA)]were detected before and after treatment.The hematoma area,uterine spiral artery peak systolic blood flow velocity(PSV),end diastolic blood flow velocity(EDV)and resistance index(RI)were detected by ultrasound.Results After treatment,there was no statistically significant difference between the observation group and the control group in total effective rate(P>0.05),but the observation group was significantly higher than the control group,and the TCM syndrome score after treatment was significantly lower than the control group(P>0.05).After treatment,the serum E2,P,β-HCG of the two groups were significantly higher than that before the treatment,and the observation group was significantly higher than the control group(P<0.05);the serum IL-4 and IL-10 of the two groups were higher after treatment This group increased before treatment,serum TNF-α,INF-γ,and INF-γ/IL-4 ratios were lower than those before treatment in this group,APTT and PT were longer than those before treatment in this group,and DD and FIB were lower than those before treatment in this group,The area of hematoma and RI of the uterine spiral artery were lower than those before the treatment,while the PSV and EDV of the uterine spiral artery were higher than those before the treatment,and the differences between the groups after treatment were statistically significant(P<0.05).The full-term pregnancy rate and the success rate of pregnancy loss in the observation group were significantly higher than those in the control group(P<0.05).And the incidence of pregnancy-induced hypertension(PIH)was significantly lower than in the control group(P<0.05).Conclusion Bushen Yangxue Decoction combined with low molecular weight heparin and dydrogesterone can improve the clinical symptoms of threatened abortion patients with IUH,regulate sex hormone levels and immune-endocrine balance,improve the uterine placental perfusion status and prethrombotic state,and improve the pregnancy outcome.