Abstract:

Objective　To explore the effect of the Andian Huayu formula combined with western medicine on the balance of coagulation-fibrinolysis in patients with recurrent spontaneous abortion positive for anticardiolipin antibody. Methods　Sixty patients with positive anticardiolipin antibody and recurrent spontaneous abortion who visited Guangdong Women and Children Hospital from January 2021 to December 2023 were selected as the research subjects. Using the random number table method, the patients were divided into the western medicine group (30 cases) and the treatment group (30 cases). The age of the western medicine group was (30.90±3.43) years; the number of spontaneous abortions was (2.82±0.94) times. The age of the treatment group was (31.10±3.19) years, and the number of spontaneous abortions was (2.73±0.82) times. At the same time, 20 non-pregnant women of childbearing age without a history of spontaneous abortion were selected as the normal control group, with an average age of (30.37±4.24) years. The western medicine group was treated with oral western medicine. The treatment group was treated in addition with the Anding Huayu formula. Both the treatment group and the western medicine group started the treatment at least 3 months before pregnancy. After 3 months, they were instructed to have sexual intercourse for conception preparation. The treatment with both traditional Chinese medicine and western medicine was stopped when the pregnancy reached 12 weeks. The antibody clearance rate, the rate of threatened miscarriage and the pregnancy success rate were compared between the western medicine group and the treatment group. The coagulation and fibrinolysis system indicators before and after treatment in the three groups were compared [activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), antithrombin Ⅲ (AT-Ⅲ), D-dimer (D-D), fibrinogen (Fbg)]. The normal control group only compared the data before treatment. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　There was no statistically significant difference in the antibody clearance rate between the western medicine group and the treatment group (P>0.05). The rate of threatened miscarriage in the treatment group was lower than that in the western medicine group, and the pregnancy success rate was higher in the treatment group than in the western medicine group [16.67% (5/30) vs. 40.00% (12/30); 63.33% (19/30) vs. 36.67% (11/30)] (both P<0.05). Before treatment, the levels of D-D and Fbg in both the western medicine group and the treatment group were higher than those in the normal control group [(0.35±0.15) mg/L, (0.37±0.16) mg/L vs. (0.20±0.09) mg/L; (3.23±0.84) g/L, (3.08±0.68) g/L vs. (2.38±0.50) g/L] (all P<0.05); there were no statistically significant differences in the levels of APTT, PT, TT, and AT-Ⅲ among the western medicine group, the treatment group, and the normal control group (all P>0.05); there were no statistically significant differences in the levels of APTT, PT, TT, AT-Ⅲ, D-D, and Fbg between the western medicine group and the treatment group (all P>0.05). In the western medicine group, there were 12 patients whose pregnancies lasted until 12 weeks. In the treatment group, there were 19 patients whose pregnancies lasted until 12 weeks. After treatment, the levels of D-D and Fbg in the treatment group were lower than those in the western medicine group [(0.18±0.11) mg/L vs. (0.27±0.11) mg/L; (2.50±0.65) g/L vs. (2.98±0.55) g/L] (both P<0.05); there were no statistically significant differences in APTT, PT, TT, and AT-Ⅲ levels between the western medicine group and the treatment group (all P>0.05). Conclusions　The combined use of traditional Chinese medicine and western medicine can more effectively maintain the coagulation-fibrinolysis balance in patients with recurrent spontaneous abortion, improve the pre-thrombotic state, thereby increasing the pregnancy rate and improving the pregnancy outcome. It is worthy of clinical promotion.

Key words:

Recurrent spontaneous abortion, Anticardiolipin antibody, Coagulation-fibrinolysis balance, Andian Huayu , formula, Integration traditional Chinese and western medicine

摘要：

目的　探讨安奠化瘀组方联合西药对抗心磷脂抗体阳性复发性流产患者凝血-纤溶平衡的影响。方法　选取2021年1月至2023年12月在广东省妇幼保健院就诊的60例抗心磷脂抗体阳性复发性流产患者作为研究对象。采用随机数字表法，将患者分为西药组（30例）和治疗组（30例）。西药组年龄（30.90±3.43）岁；自然流产次数（2.82±0.94）次。治疗组年龄（31.10±3.19）岁，自然流产次数（2.73±0.82）次。同期选取20位育龄期、无自然流产史的非孕女性作为正常对照组，年龄（30.37±4.24）岁。西药组采用口服西药治疗，治疗组在西药组基础上联合安奠化瘀组方治疗。治疗组与西药组均在孕前至少3个月开始治疗，3个月后指导同房备孕，妊娠满12周时停止中西药治疗。比较西药组和治疗组抗体清除率、先兆流产率及妊娠成功率。比较三组治疗前后的凝血纤溶系统指标［活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、凝血酶时间（TT）、抗凝血酶Ⅲ（AT-Ⅲ）、D-二聚体（D-D）、纤维蛋白原（Fbg）］，正常对照组仅比较治疗前数据。采用独立样本t检验、配对t检验和χ²检验进行统计学分析。结果　西药组和治疗组抗体清除率比较，差异无统计学意义（P>0.05）。治疗组先兆流产率低于西药组，妊娠成功率高于西药组［16.67%（5/30）比40.00%（12/30）；63.33%（19/30）比36.67%（11/30）］（均P<0.05）。治疗前，西药组和治疗组D-D、Fbg水平均高于正常对照组［（0.35±0.15）mg/L、（0.37±0.16）mg/L比（0.20±0.09）mg/L；（3.23±0.84）g/L、（3.08±0.68）g/L比（2.38±0.50）g/L］（均P<0.05）；西药组、治疗组和正常对照组APTT、PT、TT、AT-Ⅲ水平比较，差异均无统计学意义（均P>0.05）；西药组和治疗组APTT、PT、TT、AT-Ⅲ、D-D、Fbg水平比较，差异均无统计学意义（均P>0.05）。西药组妊娠至12周患者12例，治疗组妊娠至12周患者19例。治疗后，治疗组D-D、Fbg水平均低于西药组［（0.18±0.11）mg/L比（0.27±0.11）mg/L；（2.50±0.65）g/L比（2.98±0.55）g/L］（均P<0.05）；西药组和治疗组APTT、PT、TT、AT-Ⅲ水平比较，差异均无统计学意义（均P>0.05）。结论　中药联合西药治疗能更有效维持复发性流产患者的凝血-纤溶平衡，改善血栓前状态，从而提高妊娠率，改善妊娠结局，值得临床推广。

关键词:

复发性流产, 抗心磷脂抗体, 凝血-纤溶平衡, 安奠化瘀组方, 中西医结合