温化固胎2号方干预痰瘀互结型胰岛素抵抗复发性流产患者血清白细胞介素-8、肿瘤坏死因子-α的研究

Study on the intervention of Wenhua Gutai No.2 formula on serum IL-8 and TNF-α in patients with IR recurrent abortion of phlegm-stasis interjunction type

目的:观察二甲双胍联合温化固胎2号方治疗痰瘀互结型胰岛素抵抗复发性流产患者的临床疗效。方法:选取复发性流产伴胰岛素抵抗辨证属痰瘀互结型患者,共60例。用随机数字表生成两组数字,分为观察组(温化固胎2号方灌肠+二甲双胍片口服)和对照组(二甲双胍片口服)各30例。治疗3个月后比较两组患者白细胞介素-8、肿瘤坏死因子-α、空腹血糖、空腹胰岛素、胰岛素抵抗指数、妊娠率。结果:治疗后两组患者安全性指标均未见明显异常,患者症状体征均有所改善。治疗后,观察组与对照组空腹胰岛素均明显降低(P<0.05),血糖无明显改变(P>0.05),胰岛素抵抗指数降低但差异无统计学意义(P>0.05)。与对照组相比,治疗组血糖、胰岛素、胰岛素抵抗指数差异均无统计学意义(P>0.05)。治疗后两组白细胞介素-8、肿瘤坏死因子-α均下降,但白细胞介素-8下降明显,差异有统计学意义(P<0.05),观察组肿瘤坏死因子-α下降明显(P<0.05),对照组虽下降但差异无统计学意义(P>0.05);治疗后观察组白细胞介素-8明显低于对照组(P<0.05),肿瘤坏死因子-α虽低于对照组,但差异无统计学意义(P>0.05)。治疗后随访半年,观察组临床妊娠12例,其中12周以上妊娠8例,12周内流产1例,其余3例在12周内观察中,正常妊娠率为26.7%;对照组临床妊娠6例,12周以上妊娠2例,12周内流产4例,正常妊娠率为6.7%。两组正常妊娠率比较,差异有统计学意义(P<0.05)。结论:温化固胎2号方灌肠+二甲双胍片口服可降低血清白细胞介素-8、肿瘤坏死因子-α,改善胰岛素抵抗状态,具有抗炎、抗氧化作用,可改善盆腔、子宫循环,改善盆腔、子宫的炎性状态,并且通过全方共同作用改善胰岛素抵抗状态,终止因胰岛素抵抗和炎症引起的恶性循环,从而增加内膜容受程度,达到改善流产的目的。

Objective:To observe the clinical effect of metformin combined with Wenhua Gutai No.2 formula(温化固胎2号方)in the treatment of recurrent IR abortion of phlegm-stasis interjunction type.Methods:A total of 60 cases of recurrent IR abortion of phlegm-stasis interjunction type were randomly divided into the observation group(Wenhua Gutai No.2 formula enema plus oral administation of metformin tablet)and the control group(oral administation of metformin tablet),with 30 cases in each group.After 3 months of treatment,IL-8,TNF-α,fasting blood glucose,fasting insulin,IR index and pregnancy rate were compared between the two groups.Results:After treatment,there were no obvious abnormalities in the safety indexes in the two groups,and the symptoms and signs of the patients were ameliorated.After treatment,fasting insulin in the observation group and the control group was significantly decreased(P<0.05),blood glucose was not significantly changed(P>0.05),IR index was decreased but the difference was not statistically significant(P>0.05).Compared with the control group,there were no significant differences in blood glucose,insulin and IR index in the observation group(P>0.05).After treatment,IL-8 and TNF-αwere decreased in both groups,but IL-8 was decreased significantly(P<0.05),TNF-αwas decreased significantly in the observation group(P<0.05),but the difference was not statistically significant in the control group(P>0.05).