补肾活血法调节孕激素对不明原因复发性流产分泌晚期蜕膜化的影响

Effect of Method of Tonifying Kidney and Activating Blood Circulation Regulating Progesterone on Deciduating of URSA in Late Secretory Phase

目的:探讨补肾活血法对肾虚血瘀型不明原因复发性流产(Unexplained recurrent spontaneous abortion,URSA)患者分泌晚期血清孕激素(Progesterone,P)与蜕膜化因子泌催乳素(Prolactin,PRL)、胰岛素样生长因子结合蛋白-1(Insulin-Like Growth Factor Binding Protein 1,IGFBP-1)的作用及其可能机制。方法:收集30例已孕观察者[其中15例正常人工流产妇女(正常组)与15例URSA妊娠失败患者(URSA组)]和55例肾虚血瘀型URSA未孕观察者[随机分组为补肾活血法治疗组(35例)和阿司匹林对照组(20例),分别治疗4周]。运用RT-PCR法检测正常组和URSA组蜕膜组织中孕激素受体(Progesterone receptor,PR)、PRL、IGFBP-1 mRNA含量。采用ELISA法测定治疗组和对照组分泌晚期(月经周期第26天)血清中P、PRL、IGFBP-1的水平。结果:(1)URSA组PR、PRL、IGFBP-1 mRNA含量较正常组明显降低;(2)治疗组分泌晚期血清中P、PRL、IGFBP-1水平升高,且与对照组相比水平更接近于正常妇女水平。结论:(1)URSA分泌晚期血清P、蜕膜PR和PRL、IGFBP-1表达异常降低与URSA妊娠早期蜕膜化不足流产有关;(2)补肾活血法可以提高肾虚血瘀型URSA血清P、PRL、IGFBP-1水平为正常妊娠持续提供基础。

Objective:To explore the underlying mechanism on the levels of serum progesterone(P)with decidua marker prolactin(PRL)and insulin like growth factor binding protein-1(Insulin-Like Growth)in the kidney deficiency and blood stasis type of unexplained recurrent spontaneous abortion(URSA)patients during late secretory phase.Methods:Thirty cases of pregnant women[15 normal pregnant women(normal group)and 15 cases of URSA with failed pregnancy(group URSA)]and 55 cases of URSA unpregnant with kidney deficiency and blood stasis type(35 cases of patients named Bushen Huoxue Recipe group were use the method of tonifying kidney and activating blood circulation for 4 weeks and 20 cases of patients named control group were administrated aspirin for 4 weeks).RT-PCR method was used to determine the content of Progesterone receptor(PR),PRL and IGFBP-1 mRNA in decidua tissues in normal group and URSA group.The serum levels of P,PRL and IGFBP-1 in Bushen Huoxue Recipe group and control group in late secretory phase(twenty-six days of menstrual cycle)was measured by ELISA method.Results:(1)The contents of PR,PRL and IGFBP-1 mRNA in the URSA group was significantly lower than those in the normal group.(2)After treated,the levels of P,PRL and IGFBP-1 in Bushen Huoxue Recipe group during late secretory phase was increased,and the level was closer to the normal women than that of the control group.Conclusion:(1)The abnormal expressions of P in serum,decidual PR,PRL and IGFBP-1 in URSA during late secretory phase was related to the early decidua abortion in URSA pregnancy.(2)The method of tonifying kidney and activating blood circulation can improve the levels of P,PRL and IGFBP-1 in the serum of URSA patients with kidney deficiency and blood stasis type to provide the basis for normal pregnancy.