| 补肾活血化痰方对多囊卵巢综合征伴先兆流产患者保胎疗效的临床研究 |
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| 引用本文： | 吕蓓丽,王海燕,王采文,赵明智. 补肾活血化痰方对多囊卵巢综合征伴先兆流产患者保胎疗效的临床研究[J]. 上海中医药杂志, 2018, 52(12): 53-58 |
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| 作者姓名： | 吕蓓丽 王海燕 王采文 赵明智 |
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| 作者单位： | 复旦大学附属妇产科医院中西医结合科,上海,200090,复旦大学附属妇产科医院中西医结合科,上海,200090,上海中医药大学附属岳阳中西医结合医院妇科,上海,200437,复旦大学附属妇产科医院中西医结合科,上海,200090 |
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| 基金项目： | 国家自然科学基金资助项目(81873868) |
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| 摘 要： | 目的观察补肾活血化痰方对肾虚痰湿型及肾虚血瘀型多囊卵巢综合征(PCOS)伴先兆流产患者的保胎疗效。方法将149例PCOS伴先兆流产患者随机分为A组(50例)、B组(47例)和C组(52例)。A组予补肾活血化痰方,B组予黄体酮注射液治疗,C组予补肾活血化痰方联合黄体酮注射液治疗。各组均治疗至孕12周,观察临床疗效、保胎有效率及随访妊娠结局,比较中医证候积分及血清绒毛膜促性腺激素(HCG)、孕酮(P)、人胰岛素样生长因子结合蛋白-1(IGFBP-1)、纤溶酶原激活物抑制物-1(PAI-1)水平的变化情况。结果 (1)最终完成试验者146例,A组49例,B组45例,C组52例。(2)A组、B组、C组总有效率分别为85.71%、64.44%、88.46%;组间临床疗效比较,差异有统计学意义(P0.05),A组与C组相比,差异无统计学意义(P0.05),但A组、C组均优于B组(P0.05)。(3)疗程结束时,A组、B组、C组的保胎有效例数分别为42例(85.71%)、29例(64.44%)、46例(88.46%);组间保胎有效率比较,A组与C组差异无统计学意义(P0.05),但A组、C组均明显高于B组(P0.05)。(4)试验期间,A组、B组、C组的流产率分别为16.33%、40.00%、11.54%。A组与C组的流产率比较,差异无统计学意义(P0.05),但A组、C组的流产率均明显低于B组(P0.05)。(5)组间治疗后比较,A组与C组的中医证候积分差异无统计学意义(P0.05),而A组、C组的中医证候积分均明显低于B组(P0.05)。(6)各组治疗开始后(孕6、7、8、9周)与治疗前(孕5周)比较,血清HCG水平均明显上升(P0.05);治疗开始后各孕周与前一孕周比较,血清HCG水平均明显上升(P0.05)。组间治疗开始后各孕周比较,A组、C组的各孕周血清HCG水平均明显高于B组(P0.05),而C组孕6、7周的血清HCG水平又明显高于A组(P0.05)。(7)治疗前后组内比较,B组和C组的P水平明显升高(P0.05),而A组的P水平差异无统计学意义(P0.05)。组间治疗后比较,B组与C组相比,P水平差异无统计学意义(P0.05); B组、C组分别与A组比较,P水平差异有统计学意义(P0.05)。(8)治疗前后组内比较,A组和C组的IGFBP-1水平明显升高(P0.05),而PAI-1水平明显降低(P0.05),B组IGFBP-1和PAI-1水平差异无统计学意义(P0.05)。组间治疗后比较,A组与C组相比,IGFBP-1升高和PAI-1降低水平差异无统计学意义(P0.05); A组、C组分别与B组比较,IGFBP-1升高和PAI-1降低水平差异有统计学意义(P0.05)。结论补肾活血化痰方对肾虚痰湿型及肾虚血瘀型PCOS伴先兆流产患者的保胎疗效较佳,可有效调节HCG、IGFBP-1及PAI-1水平,改善临床症状,降低自然流产的发生率,提高继续妊娠率和活产率,从而改善妊娠结局。另外,对于血清P水平偏低、黄体功能不足的PCOS先兆流产患者,可同时联合黄体酮安胎治疗,达到中西医结合优势互补。
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| 关 键 词： | 补肾活血化痰方 多囊卵巢综合征 先兆流产 保胎 黄体酮 人胰岛素样生长因子结合蛋白-1 纤溶酶原激活物抑制物-1 |
| 收稿时间： | 2018-07-16 |
Clinical research on tocolysis efficacy of therapy of nourishing kidney, activating blood and resolving phlegm on polycystic ovarian syndrome with threatened abortion |
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| LYU Beili,WANG Haiyan,WANG Caiwen and ZHAO Mingzhi. Clinical research on tocolysis efficacy of therapy of nourishing kidney, activating blood and resolving phlegm on polycystic ovarian syndrome with threatened abortion[J]. Shanghai Journal of Traditional Chinese Medicine, 2018, 52(12): 53-58 |
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| Authors: | LYU Beili WANG Haiyan WANG Caiwen ZHAO Mingzhi |
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| Affiliation: | Department of Integrated Traditional Chinese and Western Medicine,Obstetrics and Gynecology Hospital Affiliated to Fudan University, Shanghai 200090, China,Department of Integrated Traditional Chinese and Western Medicine,Obstetrics and Gynecology Hospital Affiliated to Fudan University, Shanghai 200090, China,Department of Gynecology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China and Department of Integrated Traditional Chinese and Western Medicine,Obstetrics and Gynecology Hospital Affiliated to Fudan University, Shanghai 200090, China |
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