益肾化瘀方辅助治疗对不明原因复发性流产患者辅助性T细胞17/调节性T细胞平衡及雌孕激素的影响  

Effect of Yishen Huayu Prescription on Th17/Treg cell balance and estrogen-progestogen in patients with unexplained recurrent spontaneous abortion

作　　者：曹天澈 刘德佩[1] 陈聪 CAO Tianche;LIU Depei;CHEN Cong(Department of Obstetrics and Gynecology,Nanjing Integrated Traditional Chinese and Western Medicine Hospital,Nanjing,Jiangsu 210014;Department of Gynecology,Jiangsu Province Hospital of Chinese Medicine,Nanjing,Jiangsu 210009)

机构地区：[1]江苏省南京市中西医结合医院妇产科,江苏南京210014 [2]江苏省中医院妇科,江苏南京210009

出　　处：《河北中医》2024年第5期777-781,785,共6页Hebei Journal of Traditional Chinese Medicine

基　　金：江苏省卫生和计划生育委员会项目(编号:F201667)。

摘　　要：目的观察益肾化瘀方辅助治疗对不明原因复发性流产(URSA)患者辅助性T细胞17(Th17)/调节性T细胞(Treg)平衡及雌孕激素的影响。方法将92例URSA患者按照随机数字表法分为2组,对照组46例予西医常规治疗,治疗46例在对照组基础上联合益肾化瘀方治疗,连续治疗至孕12周。比较2组中医证候积分、Th17/Treg细胞水平、Th17和Treg相关细胞因子[白细胞介素17A(IL-17A)、白细胞介素35(IL-35)、转化生长因子β_(1)(TGF-β_(1))]、雌孕激素[血清雌二醇(E_(2))、孕酮(P)、β人绒毛膜促性腺激素(β-HCG)]水平、中医证候疗效、保胎成功率。结果治疗组总有效率96.65%(44/46),对照组总有效率82.61%(38/46),治疗组高于对照组(P<0.05)。2组治疗后中医证候各项评分及总分均较本组治疗前降低(P<0.05),且治疗组治疗后均低于对照组(P<0.05)。2组治疗后Th17细胞、Th17/Treg均较本组治疗前降低(P<0.05),Treg细胞均升高(P<0.05),且治疗组治疗后Th17细胞、Th17/Treg均低于对照组(P<0.05),Treg细胞高于对照组(P<0.05)。2组治疗后血清IL-17A均较本组治疗前降低(P<0.05),IL-35、TGF-β_(1)均升高(P<0.05),且治疗组治疗后血清IL-17A水平低于对照组(P<0.05),IL-35、TGF-β_(1)水平均高于对照组(P<0.05)。2组治疗后血清E_(2)、P、β-HCG均较本组治疗前升高(P<0.05),且治疗组治疗后E_(2)、P、β-HCG均高于对照组(P<0.05)。治疗组保胎成功率84.78%(39/46),对照组65.22%(30/46),治疗组高于对照组(P<0.05)。结论益肾化瘀方辅助治疗能够改善URSA临床症状,提高保胎成功率,可能与纠正Th17/Treg平衡失调、促进雌孕激素分泌等因素有关。Objective To study the effect of Yishen Huayu Prescription on T helper cell 17(Th17)/regulatory T(Treg)cell balance and estrogen-progesterone in patients with unexplained recurrent spontaneous abortion(URSA).Methods Ninety-two patients with URSA were randomly divided into treatment group(46 cases)and control group(46 cases).All patients were given routine Western medicine(RWM),those in the treatment group were additionally given Yishen Huayu Prescription.A 12-week treatment was performed in both groups.The traditional Chinese medicine(TCM)syndrome score,Th17/Treg cells level,Th17/Treg related cytokines levels(Interleukin-17A[IL-17A],IL-35,transforming growth factor-β_(1)[TGF-β_(1)]),female hormone level(estradiol[E_(2)],progesterone[P],β-human chorionic gonadotropin[β-HCG]),curative effect of TCM syndrome,the success rate of fetal protection were included as comparators between groups.Results The total effective ratein the treatment group was significantly higher than that of control group(95.65%[44/46]vs 82.61%[38/46],P<0.05).After treatment,the dimension score and total score of TCM syndrome in the both groups were significantly lower than those before treatment,and the decreases were more common in the treatment group relative to the control group(P<0.05).After treatment,Th17 cells and Th17/Treg in the both groups were significantly lower than those before treatment,while Treg cells was significantly higher(P<0.05),and the treatment group was superior to the control group for the levels of Th17 cells,Th17/Treg,Treg cells.After treatment,IL-17A in the two groups was significantly lower than that before treatment(P<0.05),while IL-35 and TGF-β_(1) were significantly higher(P<0.05).There were significant differences in serum levelsof IL-17A,IL-35 and TGF-β_(1) between the treatment group and the control group after treatment(P<0.05).E_(2),P,β-HCG in the both groups were significantly higher than those before treatment,the increases were more pronounced in the treatment group compared to the control group(P<

关 键 词：不明原因复发性流产 中药疗法 TH17/TREG 雌孕激素 

分 类 号：R714.210.531[医药卫生—妇产科学]