补肾活血方联合低分子肝素治疗非典型产科抗磷脂综合征复发性流产的临床研究
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摘要
目的观察补肾活血方联合低分子肝素治疗非经典产科抗磷脂综合征复发性流产患者的抗体转阴率及活产率,为临床诊疗提供依据。方法将2015年1月~2016年12月于浙江省立同德医院生殖免疫科门诊或住院就诊的85例非经典产科抗磷脂综合征的复发性流产患者分为两组,对照组35例用低分子肝素,实验组50例在对照组基础上加用自拟补肾活血方,比较两组的抗磷脂抗体转阴率及妊娠活产率。结果实验组抗体转阴率为90.0%,对照组抗体转阴率为82.8%,差异无统计学意义(P>0.05);实验组活产率高于对照组,差异有统计学意义(P<0.05)。结论补肾活血方联合低分子肝素能提高抗磷脂抗体转阴率,增加复发性流产患者的活产率,可作为临床治疗的有效手段之一。
Objective To observe the antibody negative conversion rate and live birth rate of Bushen Huoxue decoction combined with low molecular weight heparin in the treatment of patients with recurrent spontaneous abortion induced by atypical obstetrical anti-phospholipid syndrome, so as to provide basis for clinical diagnosis and treatment. Methods 85 patients with recurrent spontaneous abortions induced by atypical obstetrical anti-phospholipid syndrome from January 2015 to December 2016 in the Department of Reproductive Immunology in Zhejiang Provincial Tongde Hospital were divided into two groups. In the control group, 35 patients were given low-molecular-weight heparin. In the experimental group, 50 patients were further given self-made Bushen Huoxue decoction on the basis of the control group.The anti-phospholipid antibody negative conversion rate and the gestational live birth rate were compared between the two groups. Results The antibody negative conversion rate in the experimental group was 90.0%. The antibody negative conversion rate in the control group was 82.8%. There was no statistical difference between groups(P>0.05); the live birth rate in the experimental group was higher than that in the control group, and there was a statistically significant difference between the groups(P <0.05). Conclusion Bushen Huoxue decoction combined with low molecular weight heparin can increase the negative conversion rate of anti-phospholipid antibodies and increase the live birth rate of patients with recurrent spontaneous abortion. It can be used as one of the effective means in clinical treatment.
Objective To observe the antibody negative conversion rate and live birth rate of Bushen Huoxue decoction combined with low molecular weight heparin in the treatment of patients with recurrent spontaneous abortion induced by atypical obstetrical anti-phospholipid syndrome, so as to provide basis for clinical diagnosis and treatment. Methods 85 patients with recurrent spontaneous abortions induced by atypical obstetrical anti-phospholipid syndrome from January 2015 to December 2016 in the Department of Reproductive Immunology in Zhejiang Provincial Tongde Hospital were divided into two groups. In the control group, 35 patients were given low-molecular-weight heparin. In the experimental group, 50 patients were further given self-made Bushen Huoxue decoction on the basis of the control group.The anti-phospholipid antibody negative conversion rate and the gestational live birth rate were compared between the two groups. Results The antibody negative conversion rate in the experimental group was 90.0%. The antibody negative conversion rate in the control group was 82.8%. There was no statistical difference between groups(P>0.05); the live birth rate in the experimental group was higher than that in the control group, and there was a statistically significant difference between the groups(P <0.05). Conclusion Bushen Huoxue decoction combined with low molecular weight heparin can increase the negative conversion rate of anti-phospholipid antibodies and increase the live birth rate of patients with recurrent spontaneous abortion. It can be used as one of the effective means in clinical treatment.
引文
[1]谢幸,苟文丽.妇产科学[M].第8版.北京:人民卫生出版社,2013:49.
[2]中华医学会妇产科学分会产科学组.复发性流产诊治的专家共识[J].中华妇产科杂志,2016,51(1):3-9.
[3]肖世金,赵爱民.复发性流产病因学研究进展[J].中国实用妇科与产科杂志,2014,30(1):41-45.
[4]宋晗,季兰岚,周应芳,等.抗磷脂综合征与妊娠[J].中华围产医学杂志,2017,20(6):458-463.
[5]Mekinian A,Loireberson P,Nicaiseroland P,et al.Outcomes and treatment of obstetrical anti-phospholipid syndrome in women with low anti-phospholipid antibody levels[J].J Reprod Immunol,2012,94(2):222-226.
[6]Alijotasreig J,Ferreroliveras R.The European Registry on Obstetric Anti-phospholipid Syndrome(EUROAPS):a preliminary first year report[J].Lupus,2012,21(7):766-768.
[7]中华医学会风湿病学分会.抗磷脂综合征诊断和治疗指南[J].中华风湿病学杂志,2011,15(6):407-410.
[8]董盼攀,叶平.抗心磷脂抗体与反复自然流产的研究进展[J].江西中医学院学报,2013,25(5):91-93.
[9]Andreoli L,Chighizola CB,Banzato A,et al.Estimated frequency of antiphospholipid antibodies in patients with pregnancy morbidity,stroke,myocardial infarction,and deep vein thrombosis:a critical review of the literature[J].Arthritis Care Res(Hoboken),2013,65(11):1869-1873.
[10]Stern C,Chamley L.Antiphospholipid antibodies and coagulation defects in women with implantation failure after IVF and recurrent miscarriage[J].Reprod Biomed Online,2006,13(1):29-37.
[11]Ernest JM,Marshburn PB,Kutteh WH.Obstetric antiphospholipid syndrome:An update on pathophysiology and management[J].Semin Reprod Med,2011,29(6):522-539.
[12]Bizzaro N,Tonutti E,Villalta D,et al.Prevalence and clinical correlation of anti-phospholipid-binding protein antibodies in anticardiolipin-negative patients with systemic lupus erythematosus and women with unexplained recurrent miscarriages[J].Arch Pathol Lab Med,2005,129(1):61-68.
[13]Franklin RD,Kutteh WH.Antiphospholipid antibodies(APA)and recurrent pregnancy loss:Treating a unique APA positive population[J].Hum Reprod,2002,17(11):2981-2985.
[14]于若寒,孙琳,刘湘源.产科抗磷脂综合征与复发性流产的研究进展[J].发育医学电子杂志,2017,5(2):122-125.
[15]Gardiner C,Hills J,Machin SJ,et al.Diagnosis of antiphospholipid syndrome in routine clinical practice[J].Lupus,2013,22(1):18-25.
[16]Abuheija A.Thrombophilia and Recurrent Pregnancy Loss:Is heparin still the drug of choice?[J].SQUMJ,2014,14(1):26-36.
[17]Alijotas-Reig J,Ferrer-Oliveras R,Ruffatti A,et al.The European Registry on Obstetric Antiphospholipid Syndrome(EUROAPS):A survey of 247 consecutive cases[J].Autoimmun Rev,2015,14(5):387-395.
[18]叶圣龙,王永清.抗磷脂抗体综合征相关复发性流产的抗凝治疗[J].中华医学杂志,2017,97(13):1038-1040.
[19]Donnell J.Anticoagulants:Therapeutics,risks,and toxicity special emphasis on heparin-induced thrombocytopenia(HIT)[J].J Pharm Pract,2012,25(1):22-29.
[20]张玉珍.中医妇科学[M].第2版.北京:中国中医药出版社,2011:219.
[21]谢志燕.补肾活血法治疗复发性流产血栓前状态的临床观察[D].南京中医药大学,2015.
[22]陈俞材,方莲花,杜冠华.丹参水溶性化合物抗心肌缺血作用的研究进展[J].中国药理学通报,2015,31(2):162-165.
[23]董晴,陈明苍.当归化学成分及药理作用研究进展[J].亚太传统医药,2016,12(2):32-34.
[24]张明.甘肃不同产地当归质量及补血活血作用的比较研究[D].甘肃中医学院,2015.
[25]De Jesus GR,Agmon-Levin N,Andrade CA,et al.14th International Congress on Antiphospholipid Antibodies Task Force report on obstetric antiphospholipid syndrome[J].Autoimmun Rev,2014,13(8):795-813.
[26]Bramham K,Thomas M,Nelson-Piercy C,et al.Firsttrimester low-dose prednisolone in refractory antiphospholipid antibody-related pregnancy loss[J].Blood,2011,117(25):6948-6951.
[27]Dendrinos S,Sakkas E,Makrakis E.Low-molecularweight heparin versus intravenous immunoglobulin for recurrent abortion associated with antiphospholipid antibody syndrome[J].Int J Gynaecol Obstet,2009,104(3):223-225.
[28]Rodríguez García JL,Khamashta MA.Clinical ad vances of interest in the diagnosis and treatment of patients with antiphospholipid syndrome[J].Rev Clin Esp(Barc),2013,213(2):108-113.
[2]中华医学会妇产科学分会产科学组.复发性流产诊治的专家共识[J].中华妇产科杂志,2016,51(1):3-9.
[3]肖世金,赵爱民.复发性流产病因学研究进展[J].中国实用妇科与产科杂志,2014,30(1):41-45.
[4]宋晗,季兰岚,周应芳,等.抗磷脂综合征与妊娠[J].中华围产医学杂志,2017,20(6):458-463.
[5]Mekinian A,Loireberson P,Nicaiseroland P,et al.Outcomes and treatment of obstetrical anti-phospholipid syndrome in women with low anti-phospholipid antibody levels[J].J Reprod Immunol,2012,94(2):222-226.
[6]Alijotasreig J,Ferreroliveras R.The European Registry on Obstetric Anti-phospholipid Syndrome(EUROAPS):a preliminary first year report[J].Lupus,2012,21(7):766-768.
[7]中华医学会风湿病学分会.抗磷脂综合征诊断和治疗指南[J].中华风湿病学杂志,2011,15(6):407-410.
[8]董盼攀,叶平.抗心磷脂抗体与反复自然流产的研究进展[J].江西中医学院学报,2013,25(5):91-93.
[9]Andreoli L,Chighizola CB,Banzato A,et al.Estimated frequency of antiphospholipid antibodies in patients with pregnancy morbidity,stroke,myocardial infarction,and deep vein thrombosis:a critical review of the literature[J].Arthritis Care Res(Hoboken),2013,65(11):1869-1873.
[10]Stern C,Chamley L.Antiphospholipid antibodies and coagulation defects in women with implantation failure after IVF and recurrent miscarriage[J].Reprod Biomed Online,2006,13(1):29-37.
[11]Ernest JM,Marshburn PB,Kutteh WH.Obstetric antiphospholipid syndrome:An update on pathophysiology and management[J].Semin Reprod Med,2011,29(6):522-539.
[12]Bizzaro N,Tonutti E,Villalta D,et al.Prevalence and clinical correlation of anti-phospholipid-binding protein antibodies in anticardiolipin-negative patients with systemic lupus erythematosus and women with unexplained recurrent miscarriages[J].Arch Pathol Lab Med,2005,129(1):61-68.
[13]Franklin RD,Kutteh WH.Antiphospholipid antibodies(APA)and recurrent pregnancy loss:Treating a unique APA positive population[J].Hum Reprod,2002,17(11):2981-2985.
[14]于若寒,孙琳,刘湘源.产科抗磷脂综合征与复发性流产的研究进展[J].发育医学电子杂志,2017,5(2):122-125.
[15]Gardiner C,Hills J,Machin SJ,et al.Diagnosis of antiphospholipid syndrome in routine clinical practice[J].Lupus,2013,22(1):18-25.
[16]Abuheija A.Thrombophilia and Recurrent Pregnancy Loss:Is heparin still the drug of choice?[J].SQUMJ,2014,14(1):26-36.
[17]Alijotas-Reig J,Ferrer-Oliveras R,Ruffatti A,et al.The European Registry on Obstetric Antiphospholipid Syndrome(EUROAPS):A survey of 247 consecutive cases[J].Autoimmun Rev,2015,14(5):387-395.
[18]叶圣龙,王永清.抗磷脂抗体综合征相关复发性流产的抗凝治疗[J].中华医学杂志,2017,97(13):1038-1040.
[19]Donnell J.Anticoagulants:Therapeutics,risks,and toxicity special emphasis on heparin-induced thrombocytopenia(HIT)[J].J Pharm Pract,2012,25(1):22-29.
[20]张玉珍.中医妇科学[M].第2版.北京:中国中医药出版社,2011:219.
[21]谢志燕.补肾活血法治疗复发性流产血栓前状态的临床观察[D].南京中医药大学,2015.
[22]陈俞材,方莲花,杜冠华.丹参水溶性化合物抗心肌缺血作用的研究进展[J].中国药理学通报,2015,31(2):162-165.
[23]董晴,陈明苍.当归化学成分及药理作用研究进展[J].亚太传统医药,2016,12(2):32-34.
[24]张明.甘肃不同产地当归质量及补血活血作用的比较研究[D].甘肃中医学院,2015.
[25]De Jesus GR,Agmon-Levin N,Andrade CA,et al.14th International Congress on Antiphospholipid Antibodies Task Force report on obstetric antiphospholipid syndrome[J].Autoimmun Rev,2014,13(8):795-813.
[26]Bramham K,Thomas M,Nelson-Piercy C,et al.Firsttrimester low-dose prednisolone in refractory antiphospholipid antibody-related pregnancy loss[J].Blood,2011,117(25):6948-6951.
[27]Dendrinos S,Sakkas E,Makrakis E.Low-molecularweight heparin versus intravenous immunoglobulin for recurrent abortion associated with antiphospholipid antibody syndrome[J].Int J Gynaecol Obstet,2009,104(3):223-225.
[28]Rodríguez García JL,Khamashta MA.Clinical ad vances of interest in the diagnosis and treatment of patients with antiphospholipid syndrome[J].Rev Clin Esp(Barc),2013,213(2):108-113.