补肾调周法治疗同种免疫型复发性流产的临床研究

发布时间：2018-04-14 07:03

本文选题：补肾调周 + 封闭抗体　；参考：《南京中医药大学》2014年硕士论文

【摘要】：目的通过观察中医补肾调周法对同种免疫型复发性流产的临床疗效,探讨补肾调周法对同种免疫型复发性流产的作用机制,并探讨在中药治疗下,封闭抗体、Th1细胞因子、Th2细胞因子对妊娠免疫耐受的影响。方法纳入封闭抗体不足致复发性流产患者40例,给予补肾调周中药口服,3个月为一个疗程。观察：(1)治疗后血清封闭抗体转阳情况。(2)治疗后TNF-α、IL-6、TNF-α/IL-6的变化；(2)治疗后临床证候的改善情况；(3)治疗后妊娠成功者血清封闭抗体转阳情况。结果 (1)封闭抗体转阳情况：治疗后抗CD3-BE阳性率与治疗前相比,差异具有统计学意义,P0.05；抗CD4-BE阳性率与治疗前相比,差异无统计学意义,P0.05；抗CD8-BE阳性率与治疗前相比,差异具有统计学意义,P0.05。 (2)症候积分：治疗前后各证候积分比较,治疗后积分明显小于治疗前积分,差异均具有统计学意义,P0.0I；治疗前后总积分比较,治疗后总积分明显小于治疗前总积分,差异有统计学意义,P0.01。 (3)妊娠成功与封闭抗体转阳情况：妊娠16例,成功15例,妊娠成功率93.75%；妊娠成功患者中,封闭抗体均阳性者仅2例,占妊娠成功总数的13.33%,封闭抗体三项均阳性占妊娠成功13.33%,两项阳性占53.33%,一项阳性占20.00%,三项均为阴性者占13.33%。 (4)辅助性T淋巴细胞因子检测情况：治疗前患者外周血TNF-α为183.11±47.29pg/ml,治疗后下降为80.67±38.65pg/ml；IL-6治疗前为3.64±1.78pg/ml,治疗后上升为6.90±3.18pg/ml; TNF-α/IL-6治疗前为63.78±37.10,治疗后下降为15.71±13.23,治疗前后对比检验均为P0.05,具有统计学意义。 (5)临床综合疗效：临床治愈率为37.50%,均为妊娠成功者,显效率为2.50%,有效率为57.50%,总有效率97.50%。结论中医补肾调周法能明显改善同种免疫型复发性流产患者脾肾两虚的临床证候,提高妊娠成功率,还可提高血清封闭抗体抗CD3-BE、抗CD8-BE转阳率；降低TNF-α/IL-6的比值；在补肾调周中药作用下,封闭抗体未转阳者依然能妊娠成功,推测中药治疗可影响封闭抗体对妊娠的免疫耐受,可能是通过降调Thl细胞因子的表达,升高Th2细胞因子的表达,从而降低Th1/Th2比值来实现的。
[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- 伪 and IL-6 / TNF- 伪 / 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- 伪 was 183.11 卤47.29 PG / ml before treatment, decreased to 80.67 卤38.65 PG / ml before treatment, and increased to 6.90 卤3.18 PG / ml after treatment. TNF- 伪 / IL-6 decreased to 15.71 卤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- 伪 / IL-6 and decrease the ratio of TNF- 伪 / 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.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.21

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