本文選題：益氣補(bǔ)腎方　切入點：母-胎免疫識別低下　出處：《浙江中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過觀察益氣補(bǔ)腎方治療母-胎免疫識別低下型復(fù)發(fā)性流產(chǎn)患者的療效及再次妊娠結(jié)局,分析其對封閉抗體的調(diào)節(jié)作用,為臨床提供一種更加簡便、有效、低風(fēng)險、易推廣的治療途徑。方法本課題分理論研究與臨床研究兩部分理論研究：對相關(guān)文獻(xiàn)進(jìn)行整理分析,總結(jié)中西醫(yī)對母-胎免疫是被低下型復(fù)發(fā)性流產(chǎn)的診療進(jìn)展。臨床研究：收集2014年10月-2016年2月于浙江省立同德醫(yī)院生殖免疫科就診的母-胎免疫識別低下型復(fù)發(fā)性流產(chǎn)史患者108例,將其隨機(jī)分為中藥組、免疫組共兩組：中藥組采用益氣補(bǔ)腎方(炙黃芪36g,黨參15g,炒當(dāng)歸12g,炒白術(shù)18g,升麻9g,柴胡9g,陳皮9g,菟絲子30g),每日一劑,水煎分2次服,3個月為1個療程。免疫組采用配偶白細(xì)胞體外誘生免疫療法,間隔4周免疫1次,3次為1個療程。兩組均在1個療程后復(fù)查封閉抗體。若封閉抗體升高,安排受孕,繼續(xù)治療至孕16周(免疫組孕后間隔3周免疫1次)。采用SPSS19.0軟件對兩組治療前后及組間封閉抗體檢測結(jié)果進(jìn)行相關(guān)性分析,隨訪研究期間再次妊娠結(jié)局,評估臨床療效。結(jié)果①對封閉效率(BE)的影響：兩組治療后抗CD3-BE、抗CD4-BE及抗CD25-BE與治療前比較,存在顯著差異(p0.01)；治療后兩組封閉抗體抗CD3-BE、抗CD4-BE及抗CD25-BE組間比較,差異無統(tǒng)計學(xué)意義(p0.05)；抗CD3-BE治療后轉(zhuǎn)陽率：中藥組、免疫組分別為54.55%、55.81%,兩組間無統(tǒng)計學(xué)差異(p0.05)；抗CD4-BE治療后轉(zhuǎn)陽率：中藥組、免疫組分別為39.96%、41.18%,兩組間無統(tǒng)計學(xué)差異(p0.05)；抗CD25-BE治療后轉(zhuǎn)陽率：中藥組、免疫組分別為33.33%、40.38%,組間比較無統(tǒng)計學(xué)差異(p0.05)；②對封閉抗體(Ab1)及其獨特型抗體(Ab2)的影響：兩組治療后Ab1、Ab2結(jié)果與治療前比較,p0.01,存在顯著差異；治療后兩組Ab1、Ab2結(jié)果組間比較,p0.05,差異無統(tǒng)計學(xué)意義；③對再次妊娠率、再次妊娠成功率的影響：中藥組、免疫組再次妊娠例數(shù)分別為38例、37例；中藥組、免疫組再次妊娠成功(包括成功分娩及已孕16周者)分別為30例、28例；故兩組再次妊娠率分別為70.37%、68.52%；再次妊娠成功率分別為78.95%、75.68%。④妊娠結(jié)局：中藥組再次妊娠成功包含已順利生產(chǎn)17例,孕16周以上B超提示宮內(nèi)活胎發(fā)育良好13例；免疫組再次妊娠成功包括已順利生產(chǎn)14例,孕16周以上B超提示宮內(nèi)活胎發(fā)育良好14例。中藥組再次妊娠失敗包括生化妊娠5例,早期自然流產(chǎn)3例(B超未見原始心管搏動1例,B超提示胚胎發(fā)育停止2例)；免疫組再次妊娠失敗包括5例,早期自然流產(chǎn)4例(B超未見原始心管搏動2例,B超提示胚胎發(fā)育停止2例)。結(jié)論①益氣補(bǔ)腎方在治療母-胎免疫識別低下型復(fù)發(fā)性流產(chǎn)(RSA)中,能提高患者體內(nèi)封閉效率(BE)水平,與體外誘生免疫療法比較,療效相當(dāng)；②益氣補(bǔ)腎方能提高母-胎免疫識別低下型RSA患者體內(nèi)封閉抗體(Ab1)及其抗獨特型抗體(Ab2)水平,與體外誘生免疫療法比較,有顯著的相似的療效；③益氣補(bǔ)腎方與體外誘生免疫治療兩種方法對母-胎免疫識別低下型RSA患者的再次妊娠率及再次妊娠成功率相當(dāng)；④益氣補(bǔ)腎方能改善母-胎免疫識別低下型RSA的妊娠結(jié)局,減少再次流產(chǎn)的發(fā)生；⑤益氣補(bǔ)腎方可能通過提高BE、Ab1、Ab2的水平,達(dá)到調(diào)節(jié)母-胎免疫平衡的妊娠成功,與體外誘生免疫療法相比較,具有簡便、有效、低風(fēng)險、易推廣的優(yōu)點,為治療提供一種臨床依據(jù)。
[Abstract]:Objective To observe the effect of Yiqi Bushen Decoction in the treatment of maternal fetal immune recognition of low efficacy in patients with recurrent spontaneous abortion and pregnancy, analysis of the regulatory role of blocking antibodies, and provide a simple, effective, low risk for clinical treatment, easy way. Methods the topic is divided into two parts: theoretical research and clinical research theoretical research: analysis of relevant literature, summarized the traditional Chinese medicine and Western Medicine on maternal fetal immunity is low by advances in diagnosis and treatment of recurrent spontaneous abortion. Clinical research: from October 2014 -2016 year in February in Zhejiang Province Hospital Reproductive immunization clinic of maternal fetal immune recognition of low recurrent abortion in 108 cases, will they were randomly divided into Chinese medicine group, the immune group of two groups: the treatment group treated by Yiqi Bushen Decoction (Radix Astragali 36g, dangshen 15g, fried Atractylodes Angelica 12g, 18G 9g 9g, Cimicifuga, bupleurum, tangerine peel 9g, dodder, 30g) a day Agent, water decoction served 2 times, 3 month is 1 treatment course. The immune group with paternal leukocyte in vitro induced immune therapy, immune interval of 4 weeks for 1 times, 3 times for 1 course. In two groups after 1 courses were closed. If the antibody blocking antibody for pregnancy, continue to increase the treatment to 16 weeks of pregnancy (pregnancy immune group after 3 week interval immunization 1 times) by SPSS19.0 software. The correlation analysis on the detection results of antibody blocking the two groups before and after treatment and between groups, pregnancy outcome during the follow-up study, to evaluate the clinical efficacy. Results of the sealing efficiency (BE) of the two groups after treatment of anti CD3-BE, anti CD4-BE and anti CD25-BE compared with before treatment, there were significant differences (P0.01); the two groups after treatment of blocking antibody anti CD3-BE, anti CD4-BE and anti CD25-BE group, the difference was not statistically significant (P0.05); the positive conversion rate of anti CD3-BE treatment: traditional Chinese medicine group, the immune group respectively was 54.55%, 55.81% between the two groups. No statistical difference (P0.05); the positive conversion rate of anti CD4-BE treatment: Traditional Chinese medicine group, immune group were 39.96% and 41.18%, there was no significant difference between the two groups (P0.05); the positive conversion rate of anti CD25-BE treatment: Traditional Chinese medicine group, immune group were 33.33% and 40.38%, were no significant differences between groups (P0.05) the closed; antibody (Ab1) and idiotypicantibody (Ab2): the effect of the two groups after treatment Ab1, Ab2 results compared with before treatment, P0.01, there was significant difference between the two groups after treatment; Ab1, Ab2 P0.05, the comparison between groups, the difference was not statistically significant; the pregnancy rate of success the rate of pregnancy: Traditional Chinese medicine group, pregnancy immune group were 38 cases, 37 cases; traditional Chinese medicine group, the immune group again successful pregnancy (including successful delivery and has been pregnant for 16 weeks) were 30 cases, 28 cases; the two groups of pregnancy rates were 70.37%, 68.52% respectively; the success rate pregnancy 78.95%, the Chinese medicine group: 75.68%. pregnancy outcome pregnancy success included has been successfully produced in 17 cases, more than 16 weeks of gestation b-tip live intrauterine fetal development is good in 13 cases; pregnancy success including immune group has been successfully produced in 14 cases, more than 16 weeks of gestation b-tip live intrauterine fetal development. The Chinese medicine group 14 cases of good pregnancy failed to include biochemical pregnancy in 5 cases, 3 cases of early spontaneous abortion (n = 1, B no primitive heart beat b-tip embryos stopped in 2 cases); immune group again failed pregnancy including 5 cases, 4 cases of early spontaneous abortion (B no primitive heart beat in 2 cases, B 2 cases showed that embryo development to stop). Conclusion Yiqi Bushen recipe in the treatment of maternal fetal immune recognition of low recurrent spontaneous abortion (RSA), can improve the efficiency in patients with closed (BE) level, and in vitro induced immune therapy, efficacy; the Yiqi Bushen decoction can improve the maternal fetal immune recognition Low RSA (Ab1) in patients with blocking antibody and anti idiotypic antibody (Ab2) levels, and in vitro induced immune therapy, a significant effect of similar; the spleen qi and kidney and induced in vitro on maternal fetal immune recognition is low in patients with type RSA pregnancy rate and pregnancy success rate is quite immune two kinds of treatment methods; the Yiqi Bushen decoction can improve the pregnancy outcome of maternal fetal immune recognition of low RSA, reduce the occurrence of abortion again; the spleen qi and kidney by increasing the BE, Ab1, Ab2 level, to regulate the maternal fetal immune balance pregnancy success, and in vitro induced immune therapy compared to that is a simple, effective, low risk, easy to promote, to provide a basis for clinical treatment.

【學(xué)位授予單位】：浙江中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R271.9

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