益肾壮母汤辅助治疗不明原因复发性流产对患者免疫、凝血及炎症状态的影响

Effects of Yishen zhuangmu decoction for treating women with unexplained recurrent spontaneous abortion on their statuses of immunity,coagulation,and inflammation

目的:探讨益肾壮母汤联合地屈孕酮片治疗不明原因复发性流产(URSA)对患者免疫、凝血及炎症状态的影响.方法:选择本院2020年1月—2021年6月收治的URSA患者114例,随机数字表法分为观察组与对照组各57例,对照组给予地屈孕酮片治疗,观察组在对照组治疗基础上给予益肾壮母汤治疗.比较两组免疫因子水平、炎症因子水平、性激素水平、凝血功能、中医症状积分、妊娠结局.结果:完成研究后脱落/失访5例,最终纳入统计109例,观察组54例、对照组55例.治疗后,两组IgA、IgG、IgM、C3、CD4^(+)水平均较治疗前降低,CD8^(+)水平均较治疗前升高,两组绒毛膜促性腺激素水平均升高,D-二聚体降低,基质金属蛋白酶-9、血管内皮生长因子、肿瘤坏死因子-α水平,白细胞介素-4水平升高,雌二醇、卵泡刺激素、黄体生成素水平均升高,且各指标变化幅度观察组均高于对照组(均P<0.05);两组中医证候积分均降低且观察组(4.5±2.1分)低于对照组(7.4±3.4分),观察组妊娠成功率(88.9%)高于对照组(72.7%)(均P<0.05).结论:益肾壮母汤联合地屈孕酮片能够显著提高URSA患者机体免疫能力,改善凝血功能及炎症状态,提高治疗效果和妊娠成功率.

Objective: To investigate the effect of Yishen zhuangmu decoction combined with dydrogesterone for treating women with unexplained recurrent spontaneous abortion(URSA) on their statuses of immunity, coagulation, and inflammation. Methods: A total of 114 women with URSA from January 2020 to June 2021 were selected and were divided into two groups(57 cases in each group) by random number table method from January 2020 to June 2021. The women in the control group were treated by dydrogesterone tablets, and the women in the observation group were treated by dydrogesterone tablets combined with Yishen zhuangmu decoction. The levels of immune factors, inflammatory factors, sex hormones, and coagulation function, the scores of TCM symptom, and the pregnancy outcomes of the women were compared between the two groups. Results: There were 109 women for statistics analysis in the end excepting 5 cases dropped out or failed to followed up, which included 54 cases in the observation group and 55 cases in the control group. After treatment, the levels of IgA, IgG, IgM, C3, CD4^(+), and D-dimer of the women in the two groups had decreased significantly, while the levels of CD8^(+), chorionic gonadotropin, matrix metalloproteinase-9, vascular endothelial growth factor, tumor necrosis factor-α, interleukin-4, estradiol, follicle stimulating hormone(FSH), and luteinizing hormone of the women in the two groups had increased significantly, and all of which of the women in the observation group were significantly higher than those of the women in the control group(all P<0.05). The score of TCM syndrome of the women in both groups had decreased significantly, and which(4.5±2.1 points) of the women in the observation group was significantly lower than that(7.4±3.4 points) of the women in the control group, and the success rate of pregnancy(88.9%) of the women in the observation group was significantly higher than that(72.7%)of the women in the control group(all P<0.05).Conclusion:Yishen zhuangmu decoction combined with dydrogesterone for treating the women with URSA can significantly improve their immune function,improve their blood coagulation function and inflammation status,and increase their treatment effect and pregnancy success rate.