泰山磐石散联合地屈孕酮对不明原因复发性流产的疗效及作用机制  

Effect of Taishan Panshi powder combined with dydrogesterone on unexplained recurrent abortion and its machanism

作　　者：袁力 陈雅颂[1] 钟沅月 熊雯雯[1] Yuan Li;Chen Yasong;Zhong Yuanyue;Xiong Wenwen(Department of Obstetrics,Guangdong Maternal and Child Health Hospital,Guangzhou 510000,China)

机构地区：[1]广东省妇幼保健院产科,广东广州510000

出　　处：《海军医学杂志》2023年第12期1237-1242,共6页Journal of Navy Medicine

基　　金：广东省中医药局科研课题(20212021)。

摘　　要：目的探究泰山磐石散联合地屈孕酮治疗不明原因复发性流产(URSA)的疗效及作用机制。方法选取2021年1月至2022年6月广东省妇幼保健院产科收治的180例URSA早孕患者,随机分为联合组和对照组各90例。对照组采用地屈孕酮治疗,联合组在对照组基础上加用泰山磐石散治疗。比较2组患者临床疗效、分娩结局、中医证候积分、凝血功能[纤维蛋白原(FIB)、血小板(PLT)数量、D-二聚体(D-D)]、辅助性T淋巴细胞17(Th17)/调节性T淋巴细胞(Treg)、视黄酸相关孤儿核受体γt(RORγt)、叉状螺旋转录因子(Foxp3)mRNA表达水平及不良反应发生率。结果联合组总有效率高于对照组(P<0.05);治疗后联合组中医证候积分低于对照组(P<0.05);联合组分娩成功率高于对照组(P<0.05);治疗后联合组FIB、PLT、D-D水平低于对照组(P<0.05);Th17/CD4^(+)、Th17/Treg低于对照组,Treg/CD4^(+)高于对照组(P<0.05);治疗后联合组RORγt mRNA低于对照组,Foxp3 mRNA高于对照组(P<0.05);2组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论泰山磐石散联合地屈孕酮治疗URSA效果显著,可改善机体高凝状态,通过调节RORγt、Foxp3水平表达维持Th17/Treg免疫平衡,改善症状,提高分娩成功率,且安全性高。Objective To explore the effect of Taishan Panshi powder combined with dydrogesterone on unexplained recurrent abortion(URSA)and its mechanism.Methods A total of 180 URSA patients at early pregnancy who were admitted to Guangdong Maternal and Child Health Hospital from January 2021 to June 2022 were enrolled and randomly assigned(1∶1)to combined group or control group.The control group was treated with dydrogesterone,and the combined group was treated with Taishan Panshi powder on the basis of dydrogesterone.The clinical efficacy,delivery outcome,TCM syndrome score,coagulation function(fibrinogen[FIB],platelet count[PLT],and D-dimer[D-D]),helper T lymphocyte 17(Th17)/regulatory T lymphocyte(Treg)level,the mRNA expression of retinoid-associated orphan nuclear receptorγt(RORγt)and spiral transcription factor(Foxp3),and the incidence of adverse reactions were compared between the 2 groups.Results The total effective rate of the combined group was significantly higher than that of the control group(P<0.05).After treatment,the TCM syndrome score and the levels of FIB,PLT,and D-D of the combined group were significantly lower than those of the control group(P<0.05).The combined group had higher success rate of delivery than the control group(P<0.05).Th17/CD4^(+)and Th17/Treg in the combined group were lower than those in the control group,while Treg/CD4^(+)was significantly higher than that in the control group(P<0.05).The combined group had lower RORγt mRNA level and higher Foxp3 mRNA level than the control group after treatment(P<0.05).There was no significant difference in the incidences of adverse reactions between the 2 groups(P>0.05).Conclusion Taishan Panshi powder combined with dydrogesterone has a significant effect in the treatment of URSA.It can improve hypercoagulable state,maintain Th17/Treg immunologic balance by regulating the expression of RORγt and Foxp3,improve symptoms,and increase success rate of delivery with high safety.

关 键 词：泰山磐石散 不明原因复发性流产 辅助性T淋巴细胞17 地屈孕酮 调节性T淋巴细胞 

分 类 号：R71[医药卫生—妇产科学]