【摘要】：目的:應(yīng)用全國(guó)名中醫(yī)易修珍主任經(jīng)驗(yàn)方“安胎合劑”以中醫(yī)基礎(chǔ)理論和易老學(xué)術(shù)思想為指導(dǎo)配合孕激素,對(duì)復(fù)發(fā)性流產(chǎn)(Recurrent spontaneous abortion,RSA)再次妊娠后早孕期辨證屬脾腎兩虛夾熱型的患者進(jìn)行治療,觀察患者治療后臨床癥狀的改善情況,以及對(duì)相關(guān)生殖激素、抑制素A(Inhibin-A)的影響。評(píng)價(jià)其安胎保胎的療效,為臨床治療該病提供科學(xué)有效的方法。方法:將符合納入標(biāo)準(zhǔn)的60例病例,隨機(jī)分為中西醫(yī)結(jié)合治療觀察組、西藥對(duì)照組各30例。(1)觀察組:在口服地屈孕酮10mg Bid的基礎(chǔ)上,同時(shí)口服安胎合劑;(2)對(duì)照組:口服地屈孕酮片10mg Bid;所有符合納入標(biāo)準(zhǔn)的患者自B超確認(rèn)宮內(nèi)妊娠起,開始服藥,以7天為1個(gè)觀察療程觀察治療1周后、治療2周后、治療3周后及至孕十二周。觀察兩組患者治療前后臨床癥狀的改善情況,并以中醫(yī)證候積分表統(tǒng)計(jì)評(píng)分;記錄治療前后血清人絨毛膜促性腺激素(β-HCG)、孕酮(P)、雌二醇(E2)、抑制素A(Inhibin-A)變化。采用自身前后對(duì)照與組間對(duì)照進(jìn)行統(tǒng)計(jì)分析,同時(shí)本課題著重觀察患者早孕期抑制素A(Inhibin-A)變化,則增設(shè)正常妊娠組(根據(jù)觀察組患者孕周收集30例正常妊娠孕婦對(duì)應(yīng)孕周的Inhibin-A進(jìn)行對(duì)比)。結(jié)果:(1)綜合療效:觀察組總有效率83.33%(其中痊愈8例、顯效11例、有效6例、無效5例),對(duì)照組總有效率63.33%(其中痊愈3例、顯效8例、有效8例、無效11例)。經(jīng)檢驗(yàn),差異具有統(tǒng)計(jì)學(xué)意義(P=0.0230.05,Z=-2.276)。(2)中醫(yī)臨床證候療效:觀察組總有效率86.67%(其中痊愈9例、顯效10例、有效7例、無效4例),對(duì)照組總有效率66.67%(其中痊愈4例、顯效4例、有效12例、無效10例)。經(jīng)秩和檢驗(yàn),差異極顯著(P=0.0080.05,Z=-2.663),有顯著統(tǒng)計(jì)學(xué)差異。(3)相關(guān)生殖激素水平:觀察組與對(duì)照組兩組血P、β-h CG及E2激素水平較治療前明顯升高,組內(nèi)自身前后對(duì)照具有顯著性差異(P0.01)。組間比較:觀察組在治療后1周、2周、3周及治療至孕12周血P、β-h CG及E2激素水平較對(duì)照組有所升高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)(4)血清Inhibin-A:治療前RSA患者(觀察組與對(duì)照組)平均血清抑制素A水平均低于正常妊娠組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。經(jīng)治療后,通過增設(shè)正常妊娠組,三組兩兩對(duì)比得出結(jié)論:兩組治療方案均能改善Inhibin-A水平,且觀察組在提高患者血清Inhibin-A水平方面明顯優(yōu)于對(duì)照組。結(jié)論:安胎合劑配合孕激素,在治療復(fù)發(fā)性流產(chǎn)患者再次妊娠早期的療效優(yōu)于對(duì)照組,可明顯提高RSA患者早孕期血清β-HCG、P、E2及Inhibin-A的水平;并能明顯改善脾腎兩虛夾熱型RSA患者的癥狀,其總有效率達(dá)83.33%,療效明顯優(yōu)于對(duì)照組。分析中西醫(yī)結(jié)合治療復(fù)發(fā)性流產(chǎn)可能通過促進(jìn)維持妊娠的相關(guān)生殖激素分泌,調(diào)節(jié)內(nèi)分泌平衡等途徑在治療本病中取得良好的臨床療效。說明中西醫(yī)結(jié)合聯(lián)合治療的方法,可以有效改善臨床癥狀,提高妊娠成功率,并為后續(xù)治療奠定基礎(chǔ),臨床值得推廣應(yīng)用與進(jìn)一步研究。
[Abstract]:Objective: to apply the national famous Chinese medicine director Yi Xiuzhen's experience prescription "Antii mixture", which is guided by the basic theory of traditional Chinese medicine and the academic thought of the elderly, to combine progesterone with progesterone in the treatment of recurrent abortion (Recurrent spontaneous abortion,. RSA) the patients with syndrome differentiation of spleen and kidney deficiency and heat inclusion in early pregnancy were treated. The improvement of clinical symptoms and the influence of related reproductive hormones and inhibin A (Inhibin-A) were observed. To evaluate the therapeutic effect of fetal protection and to provide a scientific and effective method for clinical treatment of the disease. Methods: 60 cases were randomly divided into two groups: the control group (n = 30) and the control group (n = 30). (1) the observation group: on the basis of oral administration of Diproprogesterone 10mg Bid, at the same time, the treatment group was treated with Anti Li mixture; (2) Control group: oral administration of 10mg Bid; All the patients who met the inclusion criteria began to take medicine as early as B ultrasound confirmed intrauterine pregnancy. After 1 week of treatment, 2 weeks of treatment, 3 weeks of treatment and 12 weeks of pregnancy, 7 days were observed as a course of treatment. To observe the improvement of clinical symptoms before and after treatment in the two groups, and to score the scores with the integral table of TCM syndromes. The changes of serum 尾-HCG), progesterone (P), estradiol (E2) and inhibin A (Inhibin-A) were recorded before and after treatment. The statistical analysis was carried out by using self-control and inter-group control. Meanwhile, the changes of inhibin A (Inhibin-A) in early pregnancy were observed. The normal pregnancy group was added (Inhibin-A of 30 normal pregnant women corresponding to gestational week were collected according to the gestational age of the patients in the observation group). Results: (1) Comprehensive efficacy: the total effective rate in the observation group was 83.33% (8 cases were cured, 11 cases were effective, 6 cases were effective and 5 cases were ineffective), and the total effective rate in the control group was 63.33% (3 cases were cured, 8 cases were effective, 8 cases were effective). Ineffective 11 cases). The results showed that the difference was statistically significant (P < 0.0230.05). The curative effect of TCM syndromes was 86.67% (9 cases were cured, 10 cases were effective, 7 cases were effective, 4 cases were ineffective). In the control group, the total effective rate was 66.67% (4 cases were cured, 4 cases were markedly effective, 12 cases were effective and 10 cases were ineffective). By rank sum test, the difference was very significant (P 0.0080.05), and there was significant statistical difference. (3) the levels of related reproductive hormones: the levels of serum P, 尾 -h CG and E2 in the observation group and the control group were significantly higher than those before treatment. There was significant difference between the two groups before and after control (P0.01). Comparison between groups: the levels of serum P, 尾 -h CG and E2 in the observation group were higher than those in the control group at 1 week, 2 weeks, 3 weeks and 12 weeks after treatment. The difference was statistically significant (P0.05) (4) the average serum inhibin A level of RSA patients (observation group and control group) was lower than that of normal pregnancy group (P0.05) before the treatment of serum Inhibin-A: (P0.05). After treatment, by adding normal pregnancy group, the comparison of the three groups reached the conclusion: the two groups of treatment can improve the level of Inhibin-A, and the observation group is obviously better than the control group in raising the serum Inhibin-A level. Conclusion: Antii mixture combined with progesterone is superior to the control group in the treatment of recurrent abortion in the early stage of pregnancy, and can obviously increase the levels of serum 尾-HCG,P,E2 and Inhibin-A in early pregnancy of patients with RSA. It can obviously improve the symptoms of RSA patients with deficiency of spleen and kidney, the total effective rate is 83.33 and the curative effect is obviously better than that of the control group. To analyze the clinical effect of combined traditional Chinese and western medicine in the treatment of recurrent abortion by promoting the secretion of related reproductive hormones and regulating endocrine balance in the treatment of this disease. It shows that the combined treatment of traditional Chinese and western medicine can effectively improve the clinical symptoms, improve the success rate of pregnancy, and lay the foundation for the follow-up treatment. It is worth popularizing the clinical application and further research.
【學(xué)位授予單位】：云南中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.21

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