先兆流产治疗的研究进展
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摘要
生物学标志物检测可判断先兆流产的预后。血清雌二醇、孕酮、β-人绒毛膜促性腺激素(β-HCG)水平减低与孕早期先兆流产密切相关,且血清糖类抗原(CA125)升高时流产风险增加,这对临床治疗先兆流产具有指导意义。中医学认为先兆流产的主要病因是肾虚,宜以补肾固冲安胎为治疗大法,方药宜选用寿胎丸加减,可辅助配合针灸治疗,从而缓解先兆流产孕妇的紧张焦虑情绪和腹背疼痛,改善其生活质量;西医治疗先兆流产的主要药物是黄体酮,其仅适用于因黄体功能不全而导致的低孕酮水平的孕早期先兆流产。
Biomarker detection can determine the prognosis of threatened abortion. The decrease of serum estradiol,progesterone, beta-human chorionic gonadotropin(β-HCG) levels are closely related to threatened abortion in early pregnancy, and the risk of abortion increases with the increase of serum saccharide antigen(CA125), which has guiding significance for clinical treatment of threatened abortion. Traditional Chinese medicine believes that the main cause of threatened abortion is kidney deficiency. It is advisable to use tonifying kidney for preventing miscarriage as a treatment method. The prescription should be supplemented with Shoutai Pills, which can assist with acupuncture treatment,thus alleviating the tension and anxiety and abdominal pain of pregnant women with threatened abortion and improving their quality of life. Progesterone is the main drug for threatened abortion in Western medicine, and it is only suitable for early pregnancy threatened abortion due to low progesterone levels caused by luteal insufficiency.
Biomarker detection can determine the prognosis of threatened abortion. The decrease of serum estradiol,progesterone, beta-human chorionic gonadotropin(β-HCG) levels are closely related to threatened abortion in early pregnancy, and the risk of abortion increases with the increase of serum saccharide antigen(CA125), which has guiding significance for clinical treatment of threatened abortion. Traditional Chinese medicine believes that the main cause of threatened abortion is kidney deficiency. It is advisable to use tonifying kidney for preventing miscarriage as a treatment method. The prescription should be supplemented with Shoutai Pills, which can assist with acupuncture treatment,thus alleviating the tension and anxiety and abdominal pain of pregnant women with threatened abortion and improving their quality of life. Progesterone is the main drug for threatened abortion in Western medicine, and it is only suitable for early pregnancy threatened abortion due to low progesterone levels caused by luteal insufficiency.
引文
[1]H.Carp.A systematic review of dydrogesterone for the treat ment of recurrent miscarriage[J].Gynecol Endocrinol,2015,31(6):422-430.
[2]Cunningham FG.Williams Obstetrics 24th edition[M].USA:McGraw-Hill Education,2014.
[3]Xu Q,Chen J,Wei Z,et al.Sex Hormone Metabolism and Threatened Abortion[J].Med Sci Monit,2017,23(23):5041-5048.
[4]Lek SM,Ku CW,Allen JCJ,et al.Validation of serum progesterone<35 nmol/L as a predictor of miscarriage among women with threatened miscarriage[J].BMC Pregnancy Childbirth,2017,17(1):78.
[5]Yal觭in I,Ta s覨kin S,Pabu觭cu EG,et al.The value of placental protein 13,β-human chorionic gonadotropinand progesterone in the prediction of miscarriages in threatenedmiscarriage patients[J].J Obstet Gynaecol,2015,35(3):283-286.
[6]Duan L,Yan D,Zeng W,et al.Predictive power progesterone combined with beta human chorionic gonadotropin measurements in the outcome of threatened miscarriage[J].Arch Gynecol Obstet,2011,283(3):431-435.
[7]Kim YJ,Shin JH,Hur JY,et al.Predictive value of serum progesterone level onβ-HCG check day in women with previous repeated miscarriages after in vitro fertilization[J].PLoS One,2017,12(7):e0 181 229.
[8]Pillai RN,Konje JC,Tincello DG,et al.Role of serum biomarkers in the prediction of outcome in women with threatened miscarriage:a systematic review and diagnostic accuracy meta-analysis[J].Hum Reprod Update,2016,22(2):228-239.
[9]杜萍.单一血清CA125水平在怀孕3个月内先兆流产的临床价值[J].实用妇产科杂志,2004,20(5):326.
[10]Xu Q,Chen J,Wei Z,et al.Sex Hormone Metabolism and Threatened Abortion[J].Med Sci Monit,2017,23:5041-5048.
[11]Cagli F,Uysal G,Oz L,et al.Serum Galectin 7 is Not Useful to Predict Abortion in the First Trimester[J].Fetal Pediatr Pathol,2018,37(3):141-146.
[12]黄玉华,何梅,魏颖楠,等.1010例早期先兆流产患者中医证型分布及妊娠结局相关因素分析[J].中国中医药信息杂志,2017,24(8):22-26.
[13]高飞霞,巫海旺,郜洁,等.寿胎丸治疗先兆流产:随机对照试验的Meta分析[J].中华中医药学刊,2016,11(34):2637-2642.
[14]罗颂平.封藏之本,静以制动-论罗元凯教授安胎的思路与方法[J].广州中医药大学学报,2006,5(23):363-365.
[15]陆启滨.夏桂成教授安胎临证经验探析[J].南京中医药大学学报,2012,2(28):188-191.
[16]田春漫,陈波.固肾安胎丸联用黄体酮对先兆流产患者血清β-HCG,P,E2和CA125水平的影响[J].中国中药杂志,2016,2(41):321-325.
[17]Zhang Y,Yan W,Ge PF,et al.Study on prevention effect of Zishen Yutai pill combined with progesterone for threatened abortion in rats[J].Asian Pac J Trop Med,2016,9(6):577-581.
[18]Li L,Ping C L,Chung TKH,et al.Systematic Review of Chinese Medicine for Miscarriage during Early Pregnancy[J].Evid Based Complement Alternat Med,2014:753856.
[19]Betts D,Smith CA,Hannah DG.Acupuncture as a therapeutic treatment option for threatened miscarriage[J].BMC Complement Altern Med,2012,12(1):20.
[20]贝剑宏,刘昱磊,刘新玉,等.针刺对冷冻胚胎移植术后早期先兆流产患者生存质量的临床评价[J].内蒙古中医药,2017,36(7):55-56.
[21]Betts D,Smith CA,Dahlen HG.Does acupuncture have a role in the treatment of threatened miscarriage?Findings from a feasibility randomised trial and semi-structured participant interviews[J].BMC Pregnancy Childbirth,2016,16(1):298.
[22]Devaseelan P,Fogarty PP,Regan L.Human chorionic gonadotrophin for threatened miscarriage[J].Cochrane Database Syst Rev,2010,12(5):CD007 422.
[23]Carp HJA.Progestogens and pregnancy loss[J].Climacteric,2018,21(4):380-384.
[24]Chan DM,Cheung KW,Yung SS,et al.A randomized double-blind controlled trial of the use of dydrogesterone in women with threatened miscarriage in the first trimester:study protocol for a randomized controlled trial[J].Trials,2016,17(1):408.
[25]Lee HJ,Park TC,Kim JH,et al.The Influence of Oral Dydrogesterone and Vaginal Progesterone on Threatened Abortion:A Systematic Review and Meta-Analysis[J].Biomed Res Int,2017:3 616 875.
[26]Turgal M,Aydin E,Ozyuncu O.Effect of micronized progesterone on fetal-placental volume in first-trimester threatened abortion[J].J Clin Ultrasound,2017,45(1):14-19.
[27]Boza A,Api M,Kayatas S,et al.Is progestogen supplementation necessary to prevent abortion?[J].J Obstet Gynaecol,2016,36(8):1076-1079.
[28]Yassaee F,Shekarriz-Foumani R,Afsari S,et al.The effect of progesterone suppositories on threatened abortion:a randomized clinical trial[J].J Reprod Infertil,2014,15(3):147-151.
[29]Ke觭ecioˇglu M,Tokmak A,Ke觭ecioˇglu TS,et al.Does progesterone therapy increase nuchal translucency in women with threatened miscarriage?[J].Ginekol Pol,2016,87(5):390-394.
[30]Giorlandino C,Cignini P,Padula F,et al.Effects of exogenous progesterone on fetal nuchal translucency:an observational prospective study[J].Am J Obstet Gynecol,2015,212(3):335.e1-7.
[2]Cunningham FG.Williams Obstetrics 24th edition[M].USA:McGraw-Hill Education,2014.
[3]Xu Q,Chen J,Wei Z,et al.Sex Hormone Metabolism and Threatened Abortion[J].Med Sci Monit,2017,23(23):5041-5048.
[4]Lek SM,Ku CW,Allen JCJ,et al.Validation of serum progesterone<35 nmol/L as a predictor of miscarriage among women with threatened miscarriage[J].BMC Pregnancy Childbirth,2017,17(1):78.
[5]Yal觭in I,Ta s覨kin S,Pabu觭cu EG,et al.The value of placental protein 13,β-human chorionic gonadotropinand progesterone in the prediction of miscarriages in threatenedmiscarriage patients[J].J Obstet Gynaecol,2015,35(3):283-286.
[6]Duan L,Yan D,Zeng W,et al.Predictive power progesterone combined with beta human chorionic gonadotropin measurements in the outcome of threatened miscarriage[J].Arch Gynecol Obstet,2011,283(3):431-435.
[7]Kim YJ,Shin JH,Hur JY,et al.Predictive value of serum progesterone level onβ-HCG check day in women with previous repeated miscarriages after in vitro fertilization[J].PLoS One,2017,12(7):e0 181 229.
[8]Pillai RN,Konje JC,Tincello DG,et al.Role of serum biomarkers in the prediction of outcome in women with threatened miscarriage:a systematic review and diagnostic accuracy meta-analysis[J].Hum Reprod Update,2016,22(2):228-239.
[9]杜萍.单一血清CA125水平在怀孕3个月内先兆流产的临床价值[J].实用妇产科杂志,2004,20(5):326.
[10]Xu Q,Chen J,Wei Z,et al.Sex Hormone Metabolism and Threatened Abortion[J].Med Sci Monit,2017,23:5041-5048.
[11]Cagli F,Uysal G,Oz L,et al.Serum Galectin 7 is Not Useful to Predict Abortion in the First Trimester[J].Fetal Pediatr Pathol,2018,37(3):141-146.
[12]黄玉华,何梅,魏颖楠,等.1010例早期先兆流产患者中医证型分布及妊娠结局相关因素分析[J].中国中医药信息杂志,2017,24(8):22-26.
[13]高飞霞,巫海旺,郜洁,等.寿胎丸治疗先兆流产:随机对照试验的Meta分析[J].中华中医药学刊,2016,11(34):2637-2642.
[14]罗颂平.封藏之本,静以制动-论罗元凯教授安胎的思路与方法[J].广州中医药大学学报,2006,5(23):363-365.
[15]陆启滨.夏桂成教授安胎临证经验探析[J].南京中医药大学学报,2012,2(28):188-191.
[16]田春漫,陈波.固肾安胎丸联用黄体酮对先兆流产患者血清β-HCG,P,E2和CA125水平的影响[J].中国中药杂志,2016,2(41):321-325.
[17]Zhang Y,Yan W,Ge PF,et al.Study on prevention effect of Zishen Yutai pill combined with progesterone for threatened abortion in rats[J].Asian Pac J Trop Med,2016,9(6):577-581.
[18]Li L,Ping C L,Chung TKH,et al.Systematic Review of Chinese Medicine for Miscarriage during Early Pregnancy[J].Evid Based Complement Alternat Med,2014:753856.
[19]Betts D,Smith CA,Hannah DG.Acupuncture as a therapeutic treatment option for threatened miscarriage[J].BMC Complement Altern Med,2012,12(1):20.
[20]贝剑宏,刘昱磊,刘新玉,等.针刺对冷冻胚胎移植术后早期先兆流产患者生存质量的临床评价[J].内蒙古中医药,2017,36(7):55-56.
[21]Betts D,Smith CA,Dahlen HG.Does acupuncture have a role in the treatment of threatened miscarriage?Findings from a feasibility randomised trial and semi-structured participant interviews[J].BMC Pregnancy Childbirth,2016,16(1):298.
[22]Devaseelan P,Fogarty PP,Regan L.Human chorionic gonadotrophin for threatened miscarriage[J].Cochrane Database Syst Rev,2010,12(5):CD007 422.
[23]Carp HJA.Progestogens and pregnancy loss[J].Climacteric,2018,21(4):380-384.
[24]Chan DM,Cheung KW,Yung SS,et al.A randomized double-blind controlled trial of the use of dydrogesterone in women with threatened miscarriage in the first trimester:study protocol for a randomized controlled trial[J].Trials,2016,17(1):408.
[25]Lee HJ,Park TC,Kim JH,et al.The Influence of Oral Dydrogesterone and Vaginal Progesterone on Threatened Abortion:A Systematic Review and Meta-Analysis[J].Biomed Res Int,2017:3 616 875.
[26]Turgal M,Aydin E,Ozyuncu O.Effect of micronized progesterone on fetal-placental volume in first-trimester threatened abortion[J].J Clin Ultrasound,2017,45(1):14-19.
[27]Boza A,Api M,Kayatas S,et al.Is progestogen supplementation necessary to prevent abortion?[J].J Obstet Gynaecol,2016,36(8):1076-1079.
[28]Yassaee F,Shekarriz-Foumani R,Afsari S,et al.The effect of progesterone suppositories on threatened abortion:a randomized clinical trial[J].J Reprod Infertil,2014,15(3):147-151.
[29]Ke觭ecioˇglu M,Tokmak A,Ke觭ecioˇglu TS,et al.Does progesterone therapy increase nuchal translucency in women with threatened miscarriage?[J].Ginekol Pol,2016,87(5):390-394.
[30]Giorlandino C,Cignini P,Padula F,et al.Effects of exogenous progesterone on fetal nuchal translucency:an observational prospective study[J].Am J Obstet Gynecol,2015,212(3):335.e1-7.