当归芍药保胎散联合低分子肝素钠治疗肾虚血瘀型复发性流产伴血栓前状态临床研究

Clinical Study on Danggui Shaoyao Baotai Powder Combined with Low-Molecular-Weight Heparin Sodium for Recurrent Spontaneous Abortion of Kidney Deficiency and Blood Stasis Type with Prothrombotic State

目的:观察当归芍药保胎散联合低分子肝素钠治疗肾虚血瘀型复发性流产(RSA)伴血栓前状态的临床疗效。方法:选取120例肾虚血瘀型RSA伴血栓前状态患者,按随机数字表法分为对照组和试验组各60例。对照组给予低分子肝素钠注射液治疗,试验组在此基础上加用当归芍药保胎散治疗。2组均治疗6周。比较2组保胎成功率、总有效率、中医证候积分、凝血功能指标、血栓弹力图指数(TEG)值、血常规指标及子宫动脉血流参数。结果:治疗后,保胎成功率试验组93.33%,高于对照组70.00%(P<0.05)。治疗后,总有效率试验组96.67%,高于对照组86.67%(P<0.05)。治疗后,2组中医证候积分,纤维蛋白原(FIB)、D-二聚体(D-D)水平,凝集块形成速率、血凝块最大强度、凝血综合指数,红细胞、白细胞计数,以及左、右侧子宫动脉阻力指数(RI)和双侧子宫动脉收缩峰值血流速度/舒张末期血流速度(S/D)比值之和均较治疗前低(P<0.05),试验组中医证候积分,FIB、D-D水平,凝集块形成速率、血凝块最大强度、凝血综合指数,红细胞、白细胞计数,以及左、右侧子宫动脉RI和双侧子宫动脉S/D比值之和均低于对照组(P<0.05);2组活化部分凝血酶时间(APTT)、凝血反应时间及试验组血细胞凝集块形成时间均较治疗前延长(P<0.05),试验组APTT、凝血反应时间及血细胞凝集块形成时间均长于对照组(P<0.05)。结论:当归芍药保胎散联合低分子肝素钠能有效缓解肾虚血瘀型RSA伴血栓前状态患者的临床症状,改善子宫动脉血流参数和凝血功能,提高保胎成功率。

Objective:To observe the clinical effect of Danggui Shaoyao Baotai Powder combined with low-molecular-weight heparin sodium on recurrent spontaneous abortion(RSA)of kidney deficiency and blood stasis type with prothrombotic state.Methods:A total of 120 cases of patients with RSA of kidney deficiency and blood stasis type with prothrombotic state were selected and divided into the control group and the trial group according to the random number table method,with 60 cases in each group.The control group was treated with low-molecular-weight heparin sodium injection,and the trial group was additionally treated with Danggui Shaoyao Baotai Powder on this basis.Both groups were treated for six weeks.The success rates of fetal protection,total effective rates,traditional Chinese medicine(TCM)syndrome scores,coagulation function indicators,thromboelastogram(TEG)values,blood routine indexes and uterine artery blood flow parameters were compared between the two groups.Results:After treatment,the success rate of fetal protection in the trial group was 93.33%,which was higher than that of 70.00%in the control group(P<0.05).After treatment,the total effective rate in the trial group was 96.67%,which was higher than that of 86.67%in the control group(P<0.05).After treatment,traditional TCM syndrome scores,fibrinogen(FIB)levels,D-dimer(D-D)levels,clot formation rates,maximum clot strength,coagulation comprehensive indexes,red blood cell count,white blood cell count,and the sum of resistance index(RI)in left and right uterine arteries and ratio of peak systolic blood flow velocity to end-diastolic blood flow velocity(S/D)in both uterine arteries were decreased when compared with those before treatment(P<0.05),and the TCM syndrome scores,FIB,D-D level,clot formation rate,maximum clot strength,coagulation comprehensive index,red blood cell count,white blood cell count,and the sum of RI in left and right uterine arteries and S/D ratio in both uterine arteries in the trial group were lower than those in the control group(P<0.05);the activated partial thromboplastin time(APTT)and coagulation reaction time in the two groups and the clot formation time of blood cells in the trial group were prolonged when compared with those before treatment(P<0.05),and the APTT,the coagulation reaction time and the clot formation time of blood cells in the trial group were longer than those in the control group(P<0.05).Conclusion:Danggui Shaoyao Baotai Powder combined with low-molecular-weight heparin sodium can effectively relieve the clinical symptoms of patients with RSA of kidney deficiency and blood stasis type with prothrombotic state,improve uterine artery blood flow parameters and coagulation function,and increase the success rate of fetal protection.