二天养胎汤联合低分子量肝素治疗复发性自然流产血栓前状态的临床研究  

Clinical study of ErtianYangtai Decoction combined with low molecular weight heparin on prethrombotic state inrecurrent spontaneous abortion patients

作　　者：向丽娟[1] 戴海青[1] 戴小萍[1] 曾根[1] 周意 XIANG Lijuan;DAI Haiqing;DAI Xiaoping;ZENG Gen;ZHOU Yi(Department of Obstetrics and Gynecology,Hainan Traditional Chinese Medicine Hospital,Haikou,Hainan 570203)

机构地区：[1]海南省中医院妇产科,海南海口570203

出　　处：《河北中医》2024年第10期1617-1622,共6页Hebei Journal of Traditional Chinese Medicine

基　　金：2021年度海南省卫生健康行业科研项目(编号:21A200368);2022年全国老中医药专家传承工作室建设项目(国中医药人教函〔2022〕75号);第七批全国老中医药专家学术经验继承工作项目(国中医药人教函〔2022〕76号)。

摘　　要：目的观察二天养胎汤联合低分子量肝素对复发性自然流产(RSA)血栓前状态的治疗效果。方法选取2021年10月至2022年11月海南省中医院妇产科门诊就诊及住院的RSA血栓前状态早期妊娠,中医辨证为肾虚血瘀患者80例,采用随机数字法将符合纳入标准患者分为2组,二天养胎汤联合低分子量肝素治疗组(联合治疗组)和低分子量肝素治疗组(肝素治疗组)。其中肝素治疗组入院后给予患者脐周皮下注射低分子量肝素4100 U,每日1次,用药至孕12周。联合治疗组同期予中药二天养胎汤口服。观察各组患者用药前后的治疗效果、中医证候评分改善情况、凝血指标及生长因子和Rho相关卷曲螺旋形成蛋白激酶/LIM激酶1/丝切蛋白(ROCK/LIMK1/Cofilin)通路相关基因表达情况。结果联合治疗组与肝素治疗组相比,其总有效率及活产率均较高,差异有统计学意义(P<0.05)。2组患者治疗前,中医证候积分无明显差别(P>0.05);2组患者治疗后与治疗前相比中医证候积分均有改善(P<0.05),但联合治疗组与肝素治疗组相比,其中医证候评分较低,差异有统计学意义(P<0.05)。2组患者治疗前,各凝血指标无明显差别(P>0.05);联合治疗组治疗后与治疗前相比各凝血指标均有改善(P<0.05);肝素治疗组治疗后与治疗前相比,其纤维蛋白原(FIB)、D-二聚体(D-D)、抗凝血酶Ⅲ(ATⅢ)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)有改善(P<0.05)。联合治疗组与肝素治疗组相比,其凝血功能指标均有不同程度的改善,差异有统计学意义(P<0.05)。2组患者治疗前,孕激素及血清相关因子无明显差别(P>0.05);联合治疗组治疗后与治疗前相比各凝血指标均有改善(P<0.05);肝素治疗组治疗后与治疗前相比,其孕酮(P)、人绒毛膜促性腺激素(β-HCG)、一氧化氮(NO)、透明质酸(HA)、血管内皮生长因子A(VEGFA)、胰岛素样生长因子-1(IGF-1)、转化生长因子β1(TGF-β1)Objective To observe the effect of ErtianYangtai Decoction combined with low molecular weight heparin(LMWH)in treatment of the prothrombotic state in recurrent spontaneous abortion(RSA)patients.Methods Eighty patients with prothrombotic state of RSA(kidney deficiency and blood stasis)during early pregnancy who visited obstetrics and gynecology clinic of Hainan Traditional Chinese Medicine Hospital from October 2021 to November 2022 were enrolled.The eligible patients were randomized to receive LMWH(subcutaneous injections of 4100 IU/d LMWH at peripheral umbilicus after admission,LMWH group)or ErtianYangtai Decoction+LMWH(combined group)for 12 weeks.The treatment effect,traditional Chinese medicine(TCM)syndrome score,coagulation index,growth factors,and related expression of Rho-associated protein kinase(ROCK)/LIM kinase 1(LIMK1)/phosphorylated cofilin(p-cofilin)signaling were included as comparators.Results The total response rate and live birth rate in the combined group were significantly higher than those of the LMWH group(P<0.05).There was no significant difference in TCM syndrome score between groups before treatment(P>0.05).After treatment,the TCM syndrome scores in the two groups were significantly lower than those before treatment(P<0.05),but the reduction was more significant in the combined group than in the LMWH group(P<0.05).There was no significant difference in coagulation index including fibrinogen(FIB),D-dimer,antithrombinⅢ(ATⅢ),activated partial thromboplastin time(APTT),prothrombin time(PT)between groups before treatment(P>0.05),whereas which in the two groups were significantly improved after treatment than those before treatment(P<0.05),the improvements were more pronounced in the combined group relative to the LMWH group(P<0.05).There was no significant difference in progesterone and serum related factors between the two groups before treatment(P>0.05),but the above indexes including progesterone(P),β-human chorionic gonadotropin(β-HCG),nitric oxide(NO),hyaluronic acid(HA),vascular endo

关 键 词：复发性流产 低分子量肝素 中西医结合疗法 

分 类 号：R714.21[医药卫生—妇产科学]