补肾活血中药治疗血栓前状态相关复发性流产  

The effect of traditional Chinese medicine of reinforcing kidney and activating blood in the treatment of recurrent spontaneous abortion associated with prethrombotic state

作　　者：王思慧[1] 杨荟璇 傅萍[1] Wang Sihui

机构地区：[1]浙江中医药大学附属杭州市中医院,310007 [2]浙江省绍兴市中医院,312099

出　　处：《浙江临床医学》2022年第2期207-210,共4页Zhejiang Clinical Medical Journal

基　　金：浙江省中医药科技计划项目(2019ZB081)。

摘　　要：目的探讨补肾活血中药治疗血栓前状态(PTS)相关复发性流产(RSA)的临床疗效。方法51例PTS相关RSA患者根据治疗方案的不同分为中药组(24例)和中西药组(27例)。中药组孕前使用自拟益肾毓麟方加减,孕后以自拟安胎方加减治疗。中西药组在中药组治疗方案的基础上联合阿司匹林片、低分子肝素针治疗。在治疗过程中,孕前每3个月、孕后每1〜2周检测比较两组的花生四烯酸(AA)途径和二磷酸腺苷(ADP)途径诱导的血小板聚集率,血浆D-二聚体含量,黄体中期及孕后子宫动脉血流变化情况,孕早期的人绒毛膜促性腺激素(HCG)、雌二醇(E2)、孕酮(P)水平,观察记录两组的不良反应发生情况,统计分析两组的中医症候积分、妊娠结局及临床疗效。结果中药组和中西药组均能够降低AA途径、ADP途径诱导的血小板聚集率,差异有统计学意义(P<0.05)。治疗后两组的血浆D-二聚体含量与治疗前比较,差异均有统计学意义(P<0.05),组间比较差异均无统计学意义(P>0.05)。治疗后两组的左、右侧子宫动脉血流阻力指数(RI)、搏动指数(PI)、收缩期峰值流速/舒张末期流速比值(S/D)分别与治疗前比较,差异均有统计学意义(P<0.05),组间比较差异均无统计学意义(P>0.05)。治疗后,两组的HCG、E2、P水平及中医证候评分均得到改善两组的保胎成功率、治疗总有效率比较,差异无统计学意义(P>0.05)。两组的不良反应发生率比较,差异有统计学意义(P<0.05),中药组发生不良反应的数量、种类均少于中西药组。结论单纯补肾活血中药治疗PTS相关RSA的疗效可靠,且效果与中西药组相当,还能够降低不良反应发生率。Objective To investigate the clinical effect of traditional Chinese medicine with reinforcing kidney and activating blood in the treatment of recurrent spontaneous(RSA)abortion associated with prethrombotic state(PTS).Methods 51 PTS associated RSA patients were divided into Chinese medicine group(n=24)and Chinese and western medicine group(n=27)according to different treatment regiments.The traditional Chinese medicine group was treated with self-made Yishen Yulin prescription before pregnancy and self-made fetal safety prescription after pregnancy.The Chinese and western medicine group was combined with aspirin tablet and low molecular weight heparin injection on the basis of the treatment plan of Chinese medicine group.During the treatment,platelet aggregation rate,plasma D-dimer content,changes of uterine artery blood flow during the middle luteal phase and after pregnancy induced by arachidonic acid(AA)pathway and adenosine diphosphate(ADP)pathway were detected and compared between the two groups every 3 months before pregnancy and every 1-2 weeks after pregnancy.The levels of human chorionic gonadotropin(HCG),estradiol(E2)and progesterone(P)in early pregnancy were observed and recorded,and the incidence of adverse reactions in the two groups were statistically analyzed.The TCM symptom scores,pregnancy outcomes and clinical efficacy of the two groups were statistically analyzed.Results The platelet aggregation rate induced by AA pathway and ADP pathway was decreased in both Chinese medicine group and Chinese and western medicine group,and the difference was statistically significant(P<0.05).There were statistically significant differences in plasma D-dimer content between the two groups after treatment and before treatment(P<0.05),but there were no statistically significant differences between the two groups(P>0.05).After treatment,there were statistically significant differences in left and right uterine artery resistance index(RI),pulsatile index(PI),peak systolic flow rate/end diastolic flow rate ratio(S/D

关 键 词：复发性流产 血栓前状态 肾虚血瘀 补肾活血 

分 类 号：R71[医药卫生—妇产科学]