补肾活血方对抗磷脂抗体阳性复发性流产患者外周血microRNA-423-5p表达的影响及疗效分析

Effect of Bushen Huoxue Formula on the expression of peripheral blood miR-423-5p and its therapeutic efficacy in recurrent spontaneous abortion patients with positive antiphospholipid antibodies

目的 探讨抗磷脂抗体阳性复发性流产(RSA)患者外周血miR-423-5p表达及补肾活血方的干预效果。方法 选取2017年5月—2019年12月河南大学淮河医院收治的92例抗磷脂抗体阳性RSA患者。将患者分为对照组和研究组,每组46例。对照组给予常规西医治疗,研究组在对照组基础上另给予补肾活血方干预,两组均持续治疗8周,并自治疗起始随访2年。对比两组患者治疗前后中医证候评分、血管生成因子及蜕膜化标志因子变化情况,统计两组患者治疗前后miR-423-5p表达及凝血功能变化情况,记录两组患者治疗期间药物安全性,统计两组患者随访期间妊娠及成功分娩情况。结果 研究组治疗前后的主证、次证中医证候评分的差值高于对照组(P <0.05)。研究组治疗前后的转化生长因子β1、血管内皮生长因子、胰岛素样生长因子结合蛋白1、miR-423-5p、凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、D-二聚体的差值高于对照组(P <0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。两组患者妊娠率比较,差异无统计学意义(P>0.05)。研究组活产率高于对照组(P <0.05)。结论 补肾活血方干预可减轻抗磷脂抗体阳性RSA患者病情,改善血管生成因子、蜕膜化标志因子、凝血功能,抑制miR-423-5p表达也较明显,可提升活产率,且安全性良好。

Objective To investigate the expression of miR-423-5p in peripheral blood of recurrent spontaneous abortion(RSA) patients with positive antiphospholipid antibodies and the therapeutic efficacy of Bushen Huoxue Formula in these patients. Methods A total of 92 RSA patients with positive antiphospholipid antibodies admitted to Huaihe Hospital of Henan University from May 2017 to December 2019 were selected and divided into control group and study group, with 46 cases in each group. The control group was given conventional Western medicine treatment, and the study group was additionally given Bushen Huoxue Formula. Both groups were treated for 8 weeks, and followed up for 2 years since the initiation of the treatment. The changes of TCM syndrome scores, angiogenesis factors and decidualization markers before and after the treatment were compared between the two groups. Changes in the expression of miR-423-5p and coagulation before and after the treatment in both groups were analyzed. Drug safety was recorded during the treatment in both groups. Pregnancy and delivery in the two groups were recorded during the follow-up. Results The differences in TCM main and secondary syndrome scores before and after the treatment in the study group were greater than those in the control group(P < 0.05). The differences in the levels of transforming growth factor β1(TGF-β1), vascular endothelial growth factor(VEGF),insulin-like growth factor binding protein 1(IGFBP-1), miR-423-5p, and D-dimer(DD) as well as prothrombin time(PT), activated partial thromboplastin time(APTT) and thrombin time(TT) before and after the treatment in the study group were also higher than those in the control group(P < 0.05). There was no significant difference in the overall incidence of adverse reactions between the two groups(P > 0.05). The pregnancy rate was not different between the two groups(P > 0.05), whereas the rate of successful delivery in the study group was higher than that in the control group(P < 0.05). Conclusions Bushen Huoxue Formula may alleviate the condition of antiphospholipid antibodies-positive RSA patients, improve angiogenesis factors, decidualization markers and coagulation, and inhibit the expression of miR-423-5p. Besides, it increases the live birth rate with few safety concerns.