目的 探討孕康顆粒聯(lián)合阿司匹林及低分子肝素鈉治療復(fù)發(fā)性流產(chǎn)的臨床療效。方法 選取2019年1月—2020年6月于河南省生殖婦產(chǎn)醫(yī)院就診的108例復(fù)發(fā)性流產(chǎn)患者為研究對(duì)象，隨機(jī)分為對(duì)照組和治療組，每組各54例。對(duì)照組口服阿司匹林腸溶片，100 mg/次，1次/d，同時(shí)皮下注射低分子肝素鈉注射液，3 200 IU/次，1次/d。治療組在對(duì)照組基礎(chǔ)上口服孕康顆粒，1袋/次，3次/d。兩組患者均連續(xù)治療10周。觀察兩組患者臨床療效，比較治療前后兩組患者激素雌二醇（E₂）、孕酮（P）和人絨毛膜促性腺激素（HCG）水平，凝血-纖溶系統(tǒng)指標(biāo)凝血酶原時(shí)間（PT）、活化部分凝血酶原時(shí)間（APTT）、血清纖溶酶原激活抑制劑1（PAI-1）水平和組織型纖溶酶原激活劑（t-PA），細(xì)胞因子白細(xì)胞介素-17（IL-17）、白細(xì)胞介素-23（IL-23）、轉(zhuǎn)化生長(zhǎng)因子-β（TGF-β）和白細(xì)胞介素-10（IL-10）水平。結(jié)果 治療后，與對(duì)照組相比，治療組臨床有效率顯著升高，差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05）。治療后，兩組E₂、P及HCG、PT、APTT及TGF-β和IL-10水平均顯著升高（P＜0.05），而IL-17、PAI-1和IL-23水平顯著降低（P＜0.05），且治療組這些指標(biāo)水平明顯好于對(duì)照組（P＜0.05）。結(jié)論 孕康顆粒聯(lián)合阿司匹林及低分子肝素鈉治療復(fù)發(fā)性流產(chǎn)的臨床療效顯著且安全性高，其中機(jī)制可能與改善復(fù)發(fā)性流產(chǎn)患者的激素水平、凝血-纖溶系統(tǒng)及調(diào)節(jié)Th17/Treg細(xì)胞失衡有關(guān)。

Objective To investigate the clinical efficacy of Yunkang Granules combined with aspirin and low molecular weight heparin sodium in treatment of recurrent abortion. Methods Patients (108 cases) with recurrent abortion in Henan Obstetrics and Gynecology Hospital from January 2019 to June 2021 were randomly divided into control and treatment group, and each had 54 cases. Patients in the control group were po administered with Aspirin Enteric-coated Tablets, 100 mg/time, once daily, and they were subcutaneous injected with Low Molecular Weight Heparin Sodium Injection, 3 200 IU/time, once daily. Patients in the treatment group were po administered with Yunkang Granules on the basis of the control group, 1 bag/time, three times daily. Patients in two groups were treated for 10 weeks. After treatment, the clinical evaluation was evaluated, the levels of hormone E₂, P, and HCG, the levels of coagulation-fibrinolysis system indexes PT, APTT and PAI-1, the levels of serum IL-17, IL-23, TGF-α and IL-10 in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was significantly higher than that of the control group, and the difference was statistically significant (P < 0.05). After treatment, the levels of E₂, P, HCG, PT, APTT, TGF-β and IL-10 in two groups were significantly increased, while the levels of IL-17 and IL-23 were significantly decreased in the treatment group (P < 0.05), and the level of these indexes in the treatment group was significantly better than that in the control group (P < 0.05). Conclusion Yunkang Granules combined with aspirin and low molecular weight heparin sodium had a significant clinical efficacy and high safety in treatment of recurrent abortion. The therapeutic mechanism may be related to improve the hormone levels, coagulation-fibrinolysis system and regulate the imbalance of Th17/Treg cells in patients with recurrent abortion.

R984

河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃聯(lián)合共建項(xiàng)目(LHGJ20220268);河南省基本科研業(yè)務(wù)費(fèi)項(xiàng)目(JBKY2022007)