地屈孕酮联合滋肾育胎丸在早期不明原因复发性流产患者保胎治疗中的效果观察

Observation on the effect of Dydrogesterone combined with Zishen Yutai Pill in the treatment of fetal preservation in patients with early unexplained recurrent spontaneous abortion

目的观察地屈孕酮联合滋肾育胎丸在早期不明原因复发性流产(unexplained recurrent spontaneous abortion,URSA)患者保胎治疗中的临床效果.方法回顾性分析2018年7月至2019年12月重庆市人口和计划生育科学技术研究院附属医院生殖中心83例早期URSA患者的临床资料,按用药方案分为对照组41例和观察组42例,对照组给予口服地屈孕酮片治疗,观察组给予地屈孕酮联合滋肾育胎丸治疗.比较两组心理状态评分、疗效、血清β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-hCG)水平、Th1(IFN-γ、TNF-α、IL-2)/Th2(IL-4、IL-6、IL-10)细胞因子水平及妊娠结局.结果治疗后,两组焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)评分均较治疗前降低,且观察组低于对照组(P<0.05);观察组总有效率为88.10%,高于对照组的68.29%(P<0.05);治疗后,两组血清β-hCG水平均较治疗前提升,且观察组血清β-hCG水平高于对照组(P<0.05);治疗后,两组血清IFN-γ、TNF-α、IL-2水平均下降,IL-4、IL-6、IL-10水平均升高,且观察组血清IFN-γ、TNF-α、IL-2水平均低于对照组,IL-4、IL-6、IL-10水平均高于对照组(P<0.05);观察组保胎成功率为88.10%,高于对照组的68.29%(P<0.05).结论地屈孕酮联合滋肾育胎丸治疗早期URSA可进一步提升疗效,缓解焦虑抑郁心理状态,改善β-hCG水平,恢复Th1/Th2细胞因子平衡,提高妊娠成功率.

Objective To observe the clinical effect of Dydrogesterone combined with Zishen Yuetai Pill in the treatment of fetal preservation in patients with early unexplained recurrent spontaneous abortion(URSA).Methods A retrospective analysis was performed on 83 patients with early URSA who were diagnosed in Affiliated Hospital of Chongqing Academy of Population and Family Planning from July 2018 to December 2019.Patients were divided into control group(n=41)and observation group(n=42)according to the medication regimen.The control group was treated with oral dydrogesterone tablets alone,while the observation group was treated with dydrogesterone combined with Zishen Yutai Pills.The psychological state score,curative effect,serumβ-human chorionic gonadotropin(β-hCG)level,Th1(IFN-γ,TNF-α,IL-2)/Th2(IL-4,IL-6,IL-10)cytokine levels and pregnancy outcome of the two groups were compared.Results After treatment,SAS and SDS scores in both groups were lower than before treatment,and the observation group was lower than the control group(P<0.05).The total effective rate was 88.10%in the observation group,which was higher than 68.29%in the control group(P<0.05).After treatment,the serum level of β-hCG in both groups was higher than that before treatment,and the serum level of β-hCG in the observation group was higher than that in the control group(P<0.05).After treatment,the serum levels of IFN-γ,TNF-α,and IL-2 decreased in both groups,while the levels of IL-4,IL-6 and IL-10 increased,and the serum levels of IFN-γ,TNF-α,and IL-2 in the observation group were lower than those in the control group,and the levels of IL-4,IL-6 and IL-10 were higher than those in the control group(P<0.05).The success rate of fetal protection in the observation group was 88.10%,which was higher than 68.29%in the control group(P<0.05).Conclusion The treatment of early URSA with Dydrogesterone combined with Zishen Yutai Pills can further improve the efficacy,alleviate anxiety and depression,improve the level of β-hCG,restore the balance of Th1/Th2 cytokine,and improve the pregnancy success rate.