静脉用免疫球蛋白联合补肾化瘀汤治疗原因不明复发性自然流产的疗效及对血栓前状态和外周血Th17/Treg免疫失衡的影响  

Effects of intravenous immunoglobulin combined with decoction for tonifying kidney and resoling stasis on unexplained recurrent spontaneous abortion and on prethrombus and peripheral blood Th17/Treg immune imbalance

作　　者：张晓姗[1] ZHANG Xiaoshan(The People＇ s Hosptial of Shaanxi Province, Xi＇ an 710068, Shaanxi, China)

机构地区：[1]陕西省人民医院,陕西西安710068

出　　处：《现代中西医结合杂志》2017年第35期3903-3905,3919,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的观察静脉用免疫球蛋白(IVIG)联合补肾化瘀汤治疗原因不明复发性自然流产(URSA)的疗效及对血栓前状态(PTS)和外周血Th17/Treg免疫失衡的影响。方法将100例URSA患者随机分为观察组50例和对照组50例,对照组给予IVIG治疗,并追踪至妊娠结束,观察组在对照组基础上补肾化瘀汤治疗。观察2组治疗前后血绒毛膜促性腺激素(HCG)、孕酮、PTS及外周血Th17/Treg细胞因子的变化情况,记录2组临床妊娠结局。结果 2组治疗后血清HCG、孕酮水平、抗凝血酶Ⅲ(AT-Ⅲ)及白细胞介素-10(IL-10)、转化生长因子-β1(TGF-β1)水平均显著升高,血清D-二聚体(D-D)、组织型纤溶酶原激活物(tPA)、纤溶酶原激活抑制剂-1(PAI-1)、IL-17、IL-6水平均显著降低,且观察组各指标改善情况均优于对照组(P均<0.05);观察组妊娠结局中活产率高于对照组(P<0.05),未活产率低于对照组(P<0.05);2组治疗期间无药物不良反应情况发生。结论 IVIG联合补肾化瘀汤治疗URSA疗效确定,可显著提高安胎成功率,改善临床结局,且作用安全,其机制可能与抑制机体PTS、促进外周血Th17/Treg免疫平衡有关。Objective It is to observe the effect of intravenous immunoglobulin （IVIG） combined with decoction for tonify- ing kidney and resoling stasis on unexplained recurrent spontaneous abortion （URSA） and on prethrombotic state （PTS） and peripheral blood Thl7/Treg immune imbalance. Methods 100 patients with URSA were randomly divided into observation group and control group, 50 cases in each group. The control group was treated with IVIG, and was tracked until the end of pregnancy, the observation group was treated with decoction for tonifying kidney and resoling stasis on the basis of therapy in the control group. The changes of HCG, progesterone, PTS and peripheral blood Th17/Treg cytokines before and after treat- ment were observed in both groups, and clinical pregnancy outcomes were recorded. Results After treatment the levels of serum HCG, progesterone, antithrombin III （AT-III） and IL-10, transforming growth factor β1 （TGF-β1） were significantly in- creased, while that of serum D-dimer （D-D） , original tissue fibrinolytic enzyme activation （t-PA） , fibrinolytic enzyme activa- tion inhibitor-1 （ PAI-1 ） , IL-17, IL-6 were decreased significantly in both groups （ P 〈 0.05 ） , the improvements of these in- dexes in the observation group were superior to the control group （P 〈 0. 05 ）. The survival rate of the pregnancy outcome in the observation group was higher while non-live production rate was lower than that in the control group （ P 〈 0. 05 ）. No ad- verse drug reactions occurred during treatment in both groups. Conclusion IVIG combined with decoction for tonifying kidney and resoling stasis has determined curative effect on URSA, they can significantly improve the success rate of fetus, improve the clinical outcome and security, its mechanism may be related to inhibit PTS, promote the peripheral blood of Th17/Treg im- mune balance.

关 键 词：静脉用免疫球蛋白 补肾化瘀汤 原因不明复发性自然流产 血栓前状态 TH17细胞 调节性T细胞 

分 类 号：R714.21[医药卫生—妇产科学]