安胎合剂配合孕激素治疗脾肾两虚夹热型复发性流产及对早孕期Inhibin-A影响的临床研究
发布时间：2018-11-08 11:05
【摘要】：目的:应用全国名中医易修珍主任经验方“安胎合剂”以中医基础理论和易老学术思想为指导配合孕激素,对复发性流产(Recurrent spontaneous abortion,RSA)再次妊娠后早孕期辨证属脾肾两虚夹热型的患者进行治疗,观察患者治疗后临床症状的改善情况,以及对相关生殖激素、抑制素A(Inhibin-A)的影响。评价其安胎保胎的疗效,为临床治疗该病提供科学有效的方法。方法:将符合纳入标准的60例病例,随机分为中西医结合治疗观察组、西药对照组各30例。(1)观察组:在口服地屈孕酮10mg Bid的基础上,同时口服安胎合剂;(2)对照组:口服地屈孕酮片10mg Bid;所有符合纳入标准的患者自B超确认宫内妊娠起,开始服药,以7天为1个观察疗程观察治疗1周后、治疗2周后、治疗3周后及至孕十二周。观察两组患者治疗前后临床症状的改善情况,并以中医证候积分表统计评分;记录治疗前后血清人绒毛膜促性腺激素(β-HCG)、孕酮(P)、雌二醇(E2)、抑制素A(Inhibin-A)变化。采用自身前后对照与组间对照进行统计分析,同时本课题着重观察患者早孕期抑制素A(Inhibin-A)变化,则增设正常妊娠组(根据观察组患者孕周收集30例正常妊娠孕妇对应孕周的Inhibin-A进行对比)。结果:(1)综合疗效:观察组总有效率83.33%(其中痊愈8例、显效11例、有效6例、无效5例),对照组总有效率63.33%(其中痊愈3例、显效8例、有效8例、无效11例)。经检验,差异具有统计学意义(P=0.0230.05,Z=-2.276)。(2)中医临床证候疗效:观察组总有效率86.67%(其中痊愈9例、显效10例、有效7例、无效4例),对照组总有效率66.67%(其中痊愈4例、显效4例、有效12例、无效10例)。经秩和检验,差异极显著(P=0.0080.05,Z=-2.663),有显著统计学差异。(3)相关生殖激素水平:观察组与对照组两组血P、β-h CG及E2激素水平较治疗前明显升高,组内自身前后对照具有显著性差异(P0.01)。组间比较:观察组在治疗后1周、2周、3周及治疗至孕12周血P、β-h CG及E2激素水平较对照组有所升高,差异具有统计学意义(P0.05)(4)血清Inhibin-A:治疗前RSA患者(观察组与对照组)平均血清抑制素A水平均低于正常妊娠组,差异具有统计学意义(P0.05)。经治疗后,通过增设正常妊娠组,三组两两对比得出结论:两组治疗方案均能改善Inhibin-A水平,且观察组在提高患者血清Inhibin-A水平方面明显优于对照组。结论:安胎合剂配合孕激素,在治疗复发性流产患者再次妊娠早期的疗效优于对照组,可明显提高RSA患者早孕期血清β-HCG、P、E2及Inhibin-A的水平;并能明显改善脾肾两虚夹热型RSA患者的症状,其总有效率达83.33%,疗效明显优于对照组。分析中西医结合治疗复发性流产可能通过促进维持妊娠的相关生殖激素分泌,调节内分泌平衡等途径在治疗本病中取得良好的临床疗效。说明中西医结合联合治疗的方法,可以有效改善临床症状,提高妊娠成功率,并为后续治疗奠定基础,临床值得推广应用与进一步研究。
[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.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.21
本文编号：2318282
[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.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.21
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