本文選題：補(bǔ)腎調(diào)周 + 封閉抗體　； 參考：《南京中醫(yī)藥大學(xué)》2014年碩士論文

【摘要】：目的通過觀察中醫(yī)補(bǔ)腎調(diào)周法對(duì)同種免疫型復(fù)發(fā)性流產(chǎn)的臨床療效,探討補(bǔ)腎調(diào)周法對(duì)同種免疫型復(fù)發(fā)性流產(chǎn)的作用機(jī)制,并探討在中藥治療下,封閉抗體、Th1細(xì)胞因子、Th2細(xì)胞因子對(duì)妊娠免疫耐受的影響。 方法納入封閉抗體不足致復(fù)發(fā)性流產(chǎn)患者40例,給予補(bǔ)腎調(diào)周中藥口服,3個(gè)月為一個(gè)療程。觀察：(1)治療后血清封閉抗體轉(zhuǎn)陽情況。(2)治療后TNF-α、IL-6、TNF-α/IL-6的變化；(2)治療后臨床證候的改善情況；(3)治療后妊娠成功者血清封閉抗體轉(zhuǎn)陽情況。 結(jié)果 (1)封閉抗體轉(zhuǎn)陽情況：治療后抗CD3-BE陽性率與治療前相比,差異具有統(tǒng)計(jì)學(xué)意義,P0.05；抗CD4-BE陽性率與治療前相比,差異無統(tǒng)計(jì)學(xué)意義,P0.05；抗CD8-BE陽性率與治療前相比,差異具有統(tǒng)計(jì)學(xué)意義,P0.05。 (2)癥候積分：治療前后各證候積分比較,治療后積分明顯小于治療前積分,差異均具有統(tǒng)計(jì)學(xué)意義,P0.0I；治療前后總積分比較,治療后總積分明顯小于治療前總積分,差異有統(tǒng)計(jì)學(xué)意義,P0.01。 (3)妊娠成功與封閉抗體轉(zhuǎn)陽情況：妊娠16例,成功15例,妊娠成功率93.75%；妊娠成功患者中,封閉抗體均陽性者僅2例,占妊娠成功總數(shù)的13.33%,封閉抗體三項(xiàng)均陽性占妊娠成功13.33%,兩項(xiàng)陽性占53.33%,一項(xiàng)陽性占20.00%,三項(xiàng)均為陰性者占13.33%。 (4)輔助性T淋巴細(xì)胞因子檢測(cè)情況：治療前患者外周血TNF-α為183.11±47.29pg/ml,治療后下降為80.67±38.65pg/ml；IL-6治療前為3.64±1.78pg/ml,治療后上升為6.90±3.18pg/ml; TNF-α/IL-6治療前為63.78±37.10,治療后下降為15.71±13.23,治療前后對(duì)比檢驗(yàn)均為P0.05,具有統(tǒng)計(jì)學(xué)意義。 (5)臨床綜合療效：臨床治愈率為37.50%,均為妊娠成功者,顯效率為2.50%,有效率為57.50%,總有效率97.50%。 結(jié)論中醫(yī)補(bǔ)腎調(diào)周法能明顯改善同種免疫型復(fù)發(fā)性流產(chǎn)患者脾腎兩虛的臨床證候,提高妊娠成功率,還可提高血清封閉抗體抗CD3-BE、抗CD8-BE轉(zhuǎn)陽率；降低TNF-α/IL-6的比值；在補(bǔ)腎調(diào)周中藥作用下,封閉抗體未轉(zhuǎn)陽者依然能妊娠成功,推測(cè)中藥治療可影響封閉抗體對(duì)妊娠的免疫耐受,可能是通過降調(diào)Thl細(xì)胞因子的表達(dá),升高Th2細(xì)胞因子的表達(dá),從而降低Th1/Th2比值來實(shí)現(xiàn)的。
[Abstract]:Objective to observe the clinical effect of tonifying the kidney and regulating the week on the recurrent abortion of the same immune type, to explore the mechanism of the method of tonifying the kidney and regulating the week on the recurrent abortion of the same immune type, and to probe into the treatment of traditional Chinese medicine.Effect of Th1 cytokine and Th2 cytokine on immune tolerance of pregnancy.Methods Forty patients with recurrent abortion caused by insufficient blocking antibody were treated with tonifying kidney and regulating week Chinese medicine orally for 3 months as a course of treatment.The changes of TNF- 偽 and IL-6 / TNF- 偽 / IL-6 after treatment were observed.Result1) the positive rate of anti CD3-BE after treatment was significantly higher than that before treatment (P 0.05), the positive rate of anti CD4-BE was not significantly different from that before treatment (P 0.05), the positive rate of anti CD8-BE was higher than that before treatment (P 0.05).The difference was statistically significant (P 0.05).(2) symptom integral: the integral of every syndrome before and after treatment was obviously smaller than that before treatment, the difference was statistically significant (P 0.0I), the total integral before and after treatment was obviously lower than that before and after treatment.The difference was statistically significant (P 0.01).(3) pregnancy success and blocking antibody conversion: 16 cases were pregnant, 15 cases were successful, the success rate of pregnancy was 93.75%, and only 2 cases were positive for blocking antibody in the successful pregnancy.The three positive items of blocking antibody accounted for 13.33% of the total successful pregnancy. Two positive items accounted for 53.33%, one positive accounted for 20.00%, and three items were negative for 13.33%.TNF- 偽 was 183.11 鹵47.29 PG / ml before treatment, decreased to 80.67 鹵38.65 PG / ml before treatment, and increased to 6.90 鹵3.18 PG / ml after treatment. TNF- 偽 / IL-6 decreased to 15.71 鹵13.23 before and after treatment.It has statistical significance.(5) Clinical comprehensive curative effect: the clinical cure rate was 37.50, all of them were successful in pregnancy, the effective rate was 2.50, the effective rate was 57.50, and the total effective rate was 97.50.Conclusion the method of tonifying the kidney and regulating the week in TCM can obviously improve the clinical syndromes of deficiency of spleen and kidney in the patients with recurrent abortion of the same immune type, increase the success rate of pregnancy, increase the rate of anti-CD3-BEand anti- conversion of serum blocking antibody, decrease the ratio of TNF- 偽 / IL-6 and decrease the ratio of TNF- 偽 / IL-6.Under the action of traditional Chinese medicine for tonifying kidney and regulating week, those who did not turn positive for blocking antibody could still get pregnant successfully. It is speculated that the treatment of traditional Chinese medicine can affect the immune tolerance of blocking antibody to pregnancy, which may be by lowering the expression of Thl cytokines and increasing the expression of Th2 cytokines.Thus reducing the ratio of Th1/Th2 to achieve.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.21

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