益气补肾方治疗母—胎免疫识别低下型复发性流产的临床疗效观察

发布时间：2018-03-03 06:51

本文选题：益气补肾方　切入点：母-胎免疫识别低下　出处：《浙江中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的通过观察益气补肾方治疗母-胎免疫识别低下型复发性流产患者的疗效及再次妊娠结局,分析其对封闭抗体的调节作用,为临床提供一种更加简便、有效、低风险、易推广的治疗途径。方法本课题分理论研究与临床研究两部分理论研究：对相关文献进行整理分析,总结中西医对母-胎免疫是被低下型复发性流产的诊疗进展。临床研究：收集2014年10月-2016年2月于浙江省立同德医院生殖免疫科就诊的母-胎免疫识别低下型复发性流产史患者108例,将其随机分为中药组、免疫组共两组：中药组采用益气补肾方(炙黄芪36g,党参15g,炒当归12g,炒白术18g,升麻9g,柴胡9g,陈皮9g,菟丝子30g),每日一剂,水煎分2次服,3个月为1个疗程。免疫组采用配偶白细胞体外诱生免疫疗法,间隔4周免疫1次,3次为1个疗程。两组均在1个疗程后复查封闭抗体。若封闭抗体升高,安排受孕,继续治疗至孕16周(免疫组孕后间隔3周免疫1次)。采用SPSS19.0软件对两组治疗前后及组间封闭抗体检测结果进行相关性分析,随访研究期间再次妊娠结局,评估临床疗效。结果①对封闭效率(BE)的影响：两组治疗后抗CD3-BE、抗CD4-BE及抗CD25-BE与治疗前比较,存在显著差异(p0.01)；治疗后两组封闭抗体抗CD3-BE、抗CD4-BE及抗CD25-BE组间比较,差异无统计学意义(p0.05)；抗CD3-BE治疗后转阳率：中药组、免疫组分别为54.55%、55.81%,两组间无统计学差异(p0.05)；抗CD4-BE治疗后转阳率：中药组、免疫组分别为39.96%、41.18%,两组间无统计学差异(p0.05)；抗CD25-BE治疗后转阳率：中药组、免疫组分别为33.33%、40.38%,组间比较无统计学差异(p0.05)；②对封闭抗体(Ab1)及其独特型抗体(Ab2)的影响：两组治疗后Ab1、Ab2结果与治疗前比较,p0.01,存在显著差异；治疗后两组Ab1、Ab2结果组间比较,p0.05,差异无统计学意义；③对再次妊娠率、再次妊娠成功率的影响：中药组、免疫组再次妊娠例数分别为38例、37例；中药组、免疫组再次妊娠成功(包括成功分娩及已孕16周者)分别为30例、28例；故两组再次妊娠率分别为70.37%、68.52%；再次妊娠成功率分别为78.95%、75.68%。④妊娠结局：中药组再次妊娠成功包含已顺利生产17例,孕16周以上B超提示宫内活胎发育良好13例；免疫组再次妊娠成功包括已顺利生产14例,孕16周以上B超提示宫内活胎发育良好14例。中药组再次妊娠失败包括生化妊娠5例,早期自然流产3例(B超未见原始心管搏动1例,B超提示胚胎发育停止2例)；免疫组再次妊娠失败包括5例,早期自然流产4例(B超未见原始心管搏动2例,B超提示胚胎发育停止2例)。结论①益气补肾方在治疗母-胎免疫识别低下型复发性流产(RSA)中,能提高患者体内封闭效率(BE)水平,与体外诱生免疫疗法比较,疗效相当；②益气补肾方能提高母-胎免疫识别低下型RSA患者体内封闭抗体(Ab1)及其抗独特型抗体(Ab2)水平,与体外诱生免疫疗法比较,有显著的相似的疗效；③益气补肾方与体外诱生免疫治疗两种方法对母-胎免疫识别低下型RSA患者的再次妊娠率及再次妊娠成功率相当；④益气补肾方能改善母-胎免疫识别低下型RSA的妊娠结局,减少再次流产的发生；⑤益气补肾方可能通过提高BE、Ab1、Ab2的水平,达到调节母-胎免疫平衡的妊娠成功,与体外诱生免疫疗法相比较,具有简便、有效、低风险、易推广的优点,为治疗提供一种临床依据。
[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.

【学位授予单位】：浙江中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R271.9

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