复发性流产患者中医治疗概况及安胎结局影响因素分析  

Status of Traditional Chinese Medicine Treatment for Recurrent Spontaneous Abortion and Analysis of Influencing Factors for Miscarriage-Preventing Outcomes in the Patients

作　　者：吴昱瑛 黄丽芝 张兆萍 梁蕴仪 陈益母 郑允玲 陈卓婷 李堉成 朱玲[2] 许丽绵[2] WU Yu-Ying;HUANG Li-Zhi;ZHANG Zhao-Ping;LIANG Yun-Yi;CHEN Yi-Mu;ZHENG Yun-Ling;CHEN Zhuo-Ting;LI Yu-Cheng;ZHU Ling;XU Li-Mian(Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China)

机构地区：[1]广州中医药大学,广东广州510405 [2]广州中医药大学第一附属医院,广东广州510405

出　　处：《广州中医药大学学报》2023年第12期3054-3061,共8页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:82174418);中华中医药学会妇科分会“滑胎(复发性流产)流行病学调查”项目(中会学术[2019]005)。

摘　　要：【目的】研究复发性流产(RSA)患者的中医治疗概况及安胎结局的影响因素。【方法】采用多中心、横断面研究方法,对全国25个省、自治区、直辖市共45家医疗单位收治的RSA患者进行问卷调查。分析RSA患者的中医治疗概况,同时按中医治疗的使用情况,将RSA患者分为纯中医治疗组和非纯中医治疗组(包括中西医结合治疗或纯西医治疗),通过多因素二分类Logistic回归分析探讨RSA患者选择中医治疗的影响因素;根据再次妊娠是否超过既往流产最长孕周,将再次妊娠的RSA患者分为安胎成功组和安胎失败组,通过多因素二分类Logistic回归分析探讨RSA患者再次妊娠安胎结局的影响因素。【结果】(1)本研究共收集问卷1403份,其中合格问卷1361份,合格率为97.0%。(2)1361例患者中,采用中西医结合治疗者862例(63.3%),纯中医治疗者491例(36.1%),纯西医治疗者8例(0.6%)。中医治疗中,口服中药汤剂治疗1245例(91.5%),口服中成药治疗663例(48.7%),应用中医外治法治疗718例(52.8%)。多因素分析结果显示:患者体质量指数(BMI)>23.9 kg·m^(-2)[OR=0.504,95%CI(0.295,0.820)]、就诊单位为市级医院[OR=0.327,95%CI(0.185,0.55)]与选择单纯中医治疗相关。(3)1361例RSA患者中,再次妊娠者656例,其中安胎成功组529例(80.6%),安胎失败组127例(19.4%)。多因素分析结果显示:年龄[OR=1.137,95%CI(1.086,1.189)]、自然流产次数[OR=1.593,95%CI(1.313,1.934)]是RSA患者再次妊娠后安胎失败的危险因素。(4)受试者工作特征(ROC)曲线分析显示,年龄、自然流产次数及二者联合预测RSA患者再次妊娠后安胎结局的曲线下面积值(AUC)分别为0.702、0.663、0.745,差异有统计学意义(P<0.01)。【结论】中医疗法在RSA的治疗中应用广泛,以中药汤剂为主;是否单纯运用中医治疗与患者BMI及就诊医院级别有关;年龄、自然流产次数是RSA患者再次妊娠后安胎失败的危险因素,且对安胎结局�Objective To investigate the status of traditional Chinese medicine(TCM)therapy for patients with recurrent spontaneous abortion(RSA)and to explore the factors influencing the miscarriage-preventing outcomes.Methods A multi-center,cross-sectional study was conducted in the RSA patients admitted to a total of 45 medical institutions from 25 provinces,autonomous regions and municipalities directly under the central government.The study was performed by questionnaire survey.TCM treatment profiles of RSA patients were analyzed.RSA patients were divided into pure TCM treatment group and non-pure TCM treatment group(including combined TCM and western medicine or pure western medicine),and then the influencing factors on the choice of TCM treatment of RSA patients were explored through multivariate binary Logistic regression analysis.According to whether the second pregnancy time exceeded the longest gestational week of previous abortion,RSA patients who were pregnant were divided into the successful miscarriage-preventing group and unsuccessful miscarriage-preventing group,and the influencing factors on the miscarriage-preventing outcomes of the next pregnancy of RSA patients were investigated by multivariate binary logistic regression analysis.Results(1)A total of 1403 questionnaires were collected in this study,of which 1361 were qualified,with a qualification rate of 97.0%.(2)Of the 1361 RSA patients,862 cases(63.3%)were treated with integrated TCM and western medicine therapy,491 cases(36.1%)were treated with pure TCM therapy,and 8 cases(0.6%)were treated with pure western medicine.In the patients adopting TCM therapy,1245 cases(91.5%)were treated with oral Chinese medicine decoction,663 cases(48.7%)were treated with oral Chinese patent medicine,and 718 cases(52.8%)were treated with external therapy of TCM.The results of multivariate analysis showed that patients’body mass index(BMI)>23.9 kg·m^(-2)[OR=0.504,95%CI(0.295,0.820)]and the medical institution of consultation being a municipal hospital[OR=0.327,95%CI(0

关 键 词：复发性流产 中医药治疗 安胎结局 影响因素 年龄 自然流产次数 

分 类 号：R271.9[医药卫生—中西医结合]