摘要
目的基于血清性激素水平及妊娠结局探究保胎灵胶囊联合地屈孕酮在先兆流产(threatened abortion,TA)中的应用价值。方法选取2022年1月至2023年1月西北妇女儿童医院收治的TA患者为研究对象,以患者年龄、身体质量指数(BMI)、孕周、孕次为匹配变量,经倾向指数匹配法按照1∶1匹配出79对有效病例分别纳入研究组和对照组。其中对照组采用口服地屈孕酮片治疗,研究组采用保胎灵胶囊联合地屈孕酮治疗。记录两组患者临床症状(腹痛、腰酸、阴道出血)消失时间,比较两组治疗前、治疗4周后血清性激素[黄体酮(P)、雌二醇(E_(2))、β人绒毛膜促性腺激素(β-hCG)]水平、血清炎症因子指标[白细胞介素4(IL-4)、白细胞介素10(IL-10)、转化生长因子β(TGF-β)]水平、子宫动脉血流动力学指标[阻力系数(RI)、收缩期舒张期比值(S/D)、搏动系数(PI)],记录治疗期间不良反应及妊娠结局。结果治疗4周后,研究组腹痛、腰酸、阴道出血时间[分别为(4.25±0.81)d、(8.32±1.10)d、(6.23±0.84)d]均短于对照组[分别为(4.58±0.88)d、(8.86±1.15)d、(6.55±0.96)d](t=2.452、3.016、2.230,P=0.015、0.003、0.027);治疗后研究组和对照组患者血清P、E_(2)、β-hCG、TGF-β水平[分别为(31.69±7.59)pg·mL^(-1)、(2370.12±92.06)ng·L^(-1)、(5250.11±443.06)U·L^(-1)、(55.03±6.04)pg·mL^(-1)和(29.15±6.97)pg·mL^(-1)、(2169.57±86.33)ng·L^(-1)、(4113.62±346.27)U·L^(-1)、(52.57±5.88)pg·mL^(-1)]均高于治疗前[分别为(26.41±6.72)pg·mL^(-1)、(913.41±48.22)ng·L^(-1)、(3001.98±288.05)U·L^(-1)、(43.66±4.67)pg·mL^(-1)和(26.59±6.84)pg·mL^(-1)、(914.02±48.36)ng·L^(-1)、(2998.97±287.95)U·L^(-1)、(43.72±4.69)pg·mL^(-1)],且研究组水平高于对照组(t=2.191、14.124、17.964、2.594,P=0.030、<0.001、<0.001、0.010);治疗后研究组和对照组血清IL-4、IL-10水平[分别为(2.09±0.68)ng·L^(-1)、(28.84±3.11)pg·mL^(-1)和(2.33±0.75)ng·L^(-1)、(30.13±4.06)pg·mL^(-1)]低于治疗前水平[分别为(2.51±0.82)ng·L^(-1)、(37.69±4.59)pg·mL^(-1)和(2.53±0.83)ng·L^(-1)、(37.74±4.62)pg·mL^(-1)],且研究组水平低于对照组(t=2.107、2.242,P=0.037、0.026);治疗后,研究组和对照组RI、S/D、PI[分别为(0.76±0.11)、(2.27±0.31)、(2.05±0.38)和(0.82±0.18)、(2.40±0.34)、(2.25±0.42)]均低于治疗前[分别为(0.96±0.29)、(4.41±0.65)、(3.14±0.52)和(0.97±0.30)、(4.38±0.61)、(3.16±0.53)],且研究组指标低于对照组(t=2.528、2.511、3.139,P=0.013、0.013、0.002);治疗期间,研究组不良反应总发生率为6.33%(5/79),对照组不良反应总发生率为7.59%(6/79),两组比较差异无统计学意义(χ^(2)=0.098,P=0.755);研究组足月妊娠率为90.67%(68/75)高于对照组足月妊娠率78.08%(57/73)(χ^(2)=4.464,P=0.035),研究组流产率2.67%(2/75)低于对照组流产率12.33%(9/73)(χ^(2)=5.020,P=0.025),研究组早产率6.67%(5/75)与对照组早产率9.59%(7/73)比较,差异无统计学意义(χ^(2)=0.424,P=0.515)。结论保胎灵胶囊联合地屈孕酮治疗TA患者能快速缓解患者临床症状,提高其血清性激素水平,减轻患者机体炎症反应,降低流产率。
Objective To explore the application value of baotailing capsule combined with dydrogesterone for threatened abortion(TA)based on serum sex hormones levels and pregnancy outcomes.Methods TA patients treated in Northwest Women’s and Children’s Hospital from January 2022 to January 2023 were selected as the research subjects.Taking age,body mass index(BMI),gestational age,and gravidity as matching variables and adopting propensity score matching method,79 pairs of effective cases were matched according to 1:1 and included in study group and control group respectively.The patients in the control group were treated with oral dydrogesterone tablets while those in the study group were given baotailing capsule combined with dydrogesterone.The disappearance duration of clinical symptoms(abdominal pain,waist soreness,vaginal bleeding)were recorded in the two groups.The levels of serum sex hormones(progesterone(P),estradiol(E_(2)),β-human chorionic gonadotropin(β-hCG)),serum inflammatory factors(interleukin-4(IL-4),interleukin-10(IL-10),transforming growth factorβ(TGF-β))and uterine artery hemodynamic indicators(resistance index(RI),systolic-diastolic ratio(S/D),pulsatility index(PI))were compared between the two groups before and 4 weeks after treatment.Adverse reactions and pregnancy outcomes during treatment were recorded.Results After 4 weeks of treatment,the duration of abdominal pain,waist soreness and vaginal bleeding in the study group was(4.25±0.81)d,(8.32±1.10)d and(6.23±0.84)d,which was shorter than that of(4.58±0.88)d,(8.86±1.15)d and(6.55±0.96)d in the control group(t=2.452,3.016,2.230,P=0.015,0.003,0.027).The levels of serum P,E_(2),β-hCG and TGF-βin study group and control group after treatment were(31.69±7.59)pg·mL^(-1),(2370.12±92.06)ng·L^(-1),(5250.11±443.06)U·L^(-1),(55.03±6.04)pg·mL^(-1);(29.15±6.97)pg·mL^(-1),(2169.57±86.33)ng·L^(-1),(4113.62±346.27)U·L^(-1),(52.57±5.88)pg·mL^(-1),which were higher than those before treatment((26.41±6.72)pg·mL^(-1),(913.41±48.22)ng·L^(-1),(3001.98±288.05)U·L^(-1),(43.66±4.67)pg·mL^(-1);(26.59±6.84)pg·mL^(-1),(914.02±48.36)ng·L^(-1),(2998.97±287.95)U·L^(-1),(43.72±4.69)pg·mL^(-1)),and they were higher in the study group than in the control(t=2.191,14.124,17.964,2.594,P=0.030,<0.001,<0.001,0.010).The levels of serum IL-4 and IL-10 in study group and control group after treatment were(2.09±0.68)ng·L^(-1),(28.84±3.11)pg·mL^(-1);(2.33±0.75)ng·L^(-1),(30.13±4.06)pg·mL^(-1),which were lower than those before treatment((2.51±0.82)ng·L^(-1),(37.69±4.59)pg·mL^(-1);(2.53±0.83)ng·L^(-1),(37.74±4.62)pg·mL^(-1)),and they were lower in the study group than in the control(t=2.107,2.242,P=0.037,0.026).The levels of RI,S/D and PI in study group and control group((0.76±0.11),(2.27±0.31),(2.05±0.38);(0.82±0.18),(2.40±0.34),(2.25±0.42))were lower than those before treatment((0.96±0.29),(4.41±0.65),(3.14±0.52);(0.97±0.30),(4.38±0.61),(3.16±0.53)),and they were lower in the study group then in the control(t=2.528,2.511,3.139,P=0.013,0.013,0.002).The total incidence of adverse reactions during treatment was 6.33%(5/79)in the study group and 7.59%(6/79)in the control,showing no statistical significance between the two groups(χ^(2)=0.098,P=0.755).The full-term pregnancy rate was 90.67%(68/75)in study group,which was higher than that of 78.08%(57/73)in the control group(χ^(2)=4.464,P=0.035).However,the abortion rate was 2.67%(2/75)in the study group and 12.33%(9/73)in the control group(χ^(2)=5.020,P=0.025).The premature birth rate showed no significant difference between the two groups(6.67%(5/75)vs 9.59%(7/73)(χ^(2)=0.424,P=0.515)).Conclusion Baotailing capsule combined with dydrogesterone is effective for the treatment of TA patients because it can quickly relieve the clinical symptoms,enhance the serum sex hormones,alleviate the inflammatory response and reduce the abortion rate.
作者
雷春花
张茜
姜利霞
王瑜
李丹
Lei Chunhua;Zhang Qian;Jiang Lixia;Wang Yu;Li Dan(Department of Obstetrics,Northwest Women’s and Children’s Hospital,Xi’an 710100,China)
出处
《中国药物应用与监测》
2025年第5期894-898,共5页
Chinese Journal of Drug Application and Monitoring
基金
陕西省自然科学基础研究计划项目(2022JM-478)。
关键词
保胎灵胶囊
地屈孕酮
先兆流产
血清性激素水平
妊娠结局
Baotailing capsule
Dydrogesterone
Threatened abortion
Serum sex hormone level
Pregnancy outcome
