益气化瘀汤联合西药治疗瘀血阻滞型稽留流产的疗效及对血清CD4^(+)、CD8^(+)和白细胞介素17的影响

Clinical efficacy of Yiqi Huayu Decoction combined with Western medicine on missed abortion of blood stasis type and its influence on serum CD4^(+)and CD8^(+)and interleukin 17

目的观察益气化瘀汤联合西药治疗瘀血阻滞型稽留流产的疗效及对血清CD4^(+)、CD8^(+)和白细胞介素17(IL-17)的影响。方法将120例瘀血阻滞型稽留流产患者按照随机数字表法分为2组,治疗组60例予益气化瘀汤联合米非司酮片和米索前列醇片序贯治疗,对照组60例予米非司酮片和米索前列醇片序贯治疗。比较2组腹痛视觉模拟评分(VAS)、阴道流血时间、阴道流血量;观察2组治疗后月经首次复潮时间及宫腔粘连、宫腔残留物发生情况;比较2组治疗前后血清CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)及IL-17水平变化;比较2组治疗后45天内清宫率;观察2组不良事件发生情况。结果研究期间治疗组失访2例,对照组失访3例。2组治疗72 h腹痛VAS均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05);治疗组阴道流血时间、阴道流血量均低于对照组(P<0.05)。治疗组治疗后月经首次复潮时间短于对照组(P<0.05),宫腔粘连、宫腔残留物发生率均低于对照组(P<0.05)。2组治疗后CD4^(+)、CD4^(+)/CD8^(+)均较本组治疗前升高(P<0.05),IL-17均较本组治疗前降低(P<0.05);治疗组治疗后CD8^(+)较本组治疗前降低(P<0.05);治疗后治疗组CD4^(+)、CD4^(+)/CD8^(+)均高于对照组(P<0.05),CD8^(+)、IL-17水平均低于对照组(P<0.05)。治疗组清宫率3.45%(2/58),对照组清宫率14.04%(8/57),治疗组清宫率低于对照组(P<0.05)。治疗组不良事件发生率5.17%(3/58),对照组不良事件发生率3.51%(2/57),2组不良事件发生率比较差异无统计学意义(P>0.05)。结论益气化瘀汤联合西药治疗瘀血阻滞型稽留流产,可改善患者临床症状,提高流产成功率,减少并发症发生,用药安全,其作用机制可能与改善患者免疫功能和炎性反应水平有关。

Objective To investigate the clinical efficacy of Yiqi Huayu Decoction combined with Western medicine on missed abortion of blood stasis type and its influence on serum CD4^(+),CD8^(+)and interleukin 17(IL-17).Methods A total of 120 cases of missed abortion of blood stasis type were randomly assigned into a control group(n=60)and a treatment group(n=60).All patients were managed by Western medicine(mifepristone and misoprostol),and patients in the treatment group were additionally given Yiqi Huayu Decoction,the treatment was performed for 45 days.The visual analogue scale(VAS)for abdominal pain,vaginal bleeding time,vaginal bleeding volume,as well as postoperative first menstruation recovery time,postoperative intrauterine adhesion and intrauterine residue were compared during treatment between the two groups.The levels of serum CD4^(+),CD8^(+),CD4^(+)/CD8^(+)and IL-17 before and after treatment were observed,the uterine clearance rate within 45 days was recorded,and the occurrence of adverse events in the two groups was assessed.Results Finally,there were 58 and 57 patients in the treatment group and the control group included in the analysis.The VAS for abdominal pain at postoperative 72 hours in the two groups was obviously lower than that in the group before treatment(P<0.05),and the decrease in the treatment group was more obvious(P<0.05).After treatment,patients in the treatment group presented significantly lower vaginal bleeding time and vaginal bleeding volume(P<0.05),significantly shorter duration of first menstruation recovery(P<0.05),as well as significantly higher the incidence of intrauterine adhesion and intrauterine residue than those of the control group(P<0.05).After treatment,CD8^(+)in the treatment group was significantly lower than that before treatment(P<0.05),CD4^(+)and CD4^(+)/CD8^(+)in the both groups were significantly higher,IL-17 in the both groups were significantly lower,CD4^(+)and CD4^(+)/CD8^(+)in the treatment group were significantly higher than those in the control group(P<0.05),and CD8^(+)and IL-17 were significantly lower than those in the control group(P<0.05).The uterine clearance rate in the treatment group was significantly lower than that of the control group(3.45%[2/58]vs 14.04%[8/57],P<0.05).The incidence of adverse events in the two groups was comparable(5.17%[3/58]vs 3.51%[2/57],P>0.05).Conclusion For patients with missed abortion of blood stasis type,Yiqi Huayu Decoction combined with Western medicine can significantly improve the clinical symptoms,which improve the success rate of abortion,and reduce the occurrence of related complications,without increasing the risk of medication safety.Its mechanism of action may be related to improving the immune function and inflammatory response level of patients.