玉屏风散加味联合阿司匹林干预RSA合并血清阴性APS及对<italic style="font-style: italic">D</italic>-二聚体，PagT的影响

吴诗敏; 谈勇

doi:10.13422/j.cnki.syfjx.20191126

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玉屏风散加味联合阿司匹林干预RSA合并血清阴性APS及对D-二聚体，PagT的影响

经典名方 | 更新时间：2021-02-09

- 玉屏风散加味联合阿司匹林干预RSA合并血清阴性APS及对D-二聚体，PagT的影响
- Intervention of Modified Yupingfeng San Combined with Aspirin on D-dimer, PagT Levels of RSA with Seronegative APS
- 中国实验方剂学杂志 2019年25卷第19期页码：10-16
- 作者机构：
  
  1.南京中医药大学，南京　 210029；
  2.南京中医药大学　附属医院，南京　 210029
- 作者简介：
  
  吴诗敏，硕士，从事不孕症研究，E-mail：wusm_2000@sina.com
  谈勇，博士，教授、主任中医师，从事辅助生殖、不孕症研究，E-mail：xijun1025@163.com
- 基金信息：
  
  江苏省研究生实践创新计划项目(SJCX18_0490);江苏省临床医学中心（创新平台）建设项目(YXZXB2016006)
- DOI：10.13422/j.cnki.syfjx.20191126
  中图分类号： R22; R242; R2-031; R287
- 收稿日期：2018-10-22，
  
  网络出版日期：2019-02-19，
  
  纸质出版日期：2019-10-05
- 稿件说明：
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吴诗敏, 谈勇. 玉屏风散加味联合阿司匹林干预RSA合并血清阴性APS及对D-二聚体，PagT的影响[J]. 中国实验方剂学杂志, 2019,25(19):10-16.

Shi-min WU, Yong TAN. Intervention of Modified Yupingfeng San Combined with Aspirin on D-dimer, PagT Levels of RSA with Seronegative APS[J]. Chinese journal of experimental traditional medical formulae, 2019, 25(19): 10-16.
吴诗敏, 谈勇. 玉屏风散加味联合阿司匹林干预RSA合并血清阴性APS及对D-二聚体，PagT的影响[J]. 中国实验方剂学杂志, 2019,25(19):10-16. DOI： 10.13422/j.cnki.syfjx.20191126.

Shi-min WU, Yong TAN. Intervention of Modified Yupingfeng San Combined with Aspirin on D-dimer, PagT Levels of RSA with Seronegative APS[J]. Chinese journal of experimental traditional medical formulae, 2019, 25(19): 10-16. DOI： 10.13422/j.cnki.syfjx.20191126.

摘要

目的：

观察玉屏风散加味联合阿司匹林治疗复发性流产(RSA)合并血清阴性抗磷脂抗体综合征(SN-APS)的临床疗效，为临床治疗提供参考。

方法：

选取2016年12月至2018年3月就诊于南京中医药大学附属医院生殖医学科的109例RSA合并SN-APS的患者进行分组研究，按照随机数字法分为空白组、对照组与观察组。空白组从孕前给予叶酸片安慰治疗，1片/次，1次/d。对照组于孕前给予阿司匹林1片/次，3次/d；丹参片4片/次，3次/d；叶酸片1片/次，1次/d治疗。观察组则于孕前给予玉屏风散加味口服，每次150 mL，2次/d，联合阿司匹林1片/次，3次/d，叶酸片1片/次，1次/d治疗，3组患者均试孕1年，并于妊娠后加用阿司匹林1片/次，3次/d，地屈孕酮1片/次，3次/d，分别观察至孕13周，流产则停药，对3组患者妊娠率、流产率、治疗前后凝血指标、中医证候评分以及流产月份等数据进行统计比较。

结果：

观察组治疗后在凝血指标

-二聚体，血小板聚集率(PagT)，中医证候评分(易感冒、自汗、恶风、神疲、乏力、腰膝酸软)较治疗前明显改善，且治疗后观察组凝血指标低于空白组(

0.05)，中医证候积分低于对照组与空白组(

0.05)，对照组治疗后凝血指标较治疗前明显降低(

0.05)；观察组治疗后流产率、超出流产月份之流产率低于空白组(

0.05)，对照组治疗后流产率明显低于空白组(

0.05)。

结论：

西药联合单味中药或中药复方干预均能提高该类患者的保胎疗效，结合中药复方可多靶点地调节机体免疫平衡，减缓血栓形成，改善中医证候，疗效更为突出，但确切疗效需要更大样本验证。而保胎至超过流产月份或许并不能改变妊娠结局，故保胎治疗应至少维持至早孕期结束。

Abstract

Objective:

To observe the clinical efficacy of aspirin combined with modified Yupingfeng San on patients with recurrent spontaneous abortion and Seronegative antiphospholipid syndrome.

Method:

From December 2016 to March 2018

109 cases of recurrent spontaneous abortion patients with seronegative antiphospholipid syndrome in Affiliated Hospital of Nanjing University of Chinese Medicine were selected as the study objects. According to the random number table

they were divided into three groups: blank group

control group and study group. The blank group was treated with folic acid tablets

1 pill/time

as placebo

the control group was treated with folic acid tablets

1 pill/time

Danshen pills

4 pills/time

tid

and aspirin

1 pill/time

tid

and the study group was treated with folic acid tablets

1 pill/time

aspirin

1 pill/time

tid

and modified Yupingfeng San

150 mL/time

bid

. These patients were all asked for pregnancy preparation for 1 year and treated with aspirin

1 pill/time

tid

and progesterone pills

1 pill/time

tid

since the beginning of pregnancy until 13 weeks or abortion. The pregnancy rate

miscarriage rate

coagulation index before and after treatment

traditional Chinese medicine (TCM) symptom score as well as months of abortion were all observed and compared.

Result:

The coagulation index and TCM symptom score of the study group were significantly lower than those before treatment (

0.05)

and the coagulation index of the control group was lower than before treatment. In terms of the coagulation index

the study group was significantly lower than the blank group (

0.05). In terms of TCM symptom scores

the study group got lower scores than other two groups (

0.05). Besides

in terms of the total abortion rate and the abortive rate beyond the months of abortion

the study group was significantly lower than the blank group (

0.05)

and the total abortion rate of the blank group was significantly higher than that of control group (

0.05).

Conclusion:

The data proved that the combination of anti-coagulation medicine with either single herb or herbal compound can improve the curative effect of the patients

and traditional Chinese herbal compound can regulate the immune system

reduce the thrombosis and improve the symptoms of TCM

which made the curative efficacy more prominent. However

more samples were needed for further research. Because the time of fetal protection may not change the outcome of pregnancy

the therapy should be maintained at least until the end of the early pregnancy.

关键词

Keywords

references

Conti F , Capozzi A , Truglia S , et al . The mosaic of ”seronegative” antiphospholipid syndrome [J]. J Immunol Res , 2014 , 2014 : 389601 .

Mohamed K A A , Saad A S . Enoxaparin and aspirin therapy for recurrent pregnancy loss due to anti-phospholipid syndrome (APS) [J]. Middle East Fertil Soc J , 2014 , 19 ( 3 ): 176 - 182 .

Rodriguez-Garcia J L , Bertolaccini M L , Cuadrado M J , et al . Clinical manifestations of antiphospholipid syndrome (APS) with and without antiphospholipid antibodies (the so-called ‘seronegative APS’) [J]. Ann Rheum Dis , 2012 , 71 ( 2 ): 242 - 244 .

Alessandri C , Conti F , Pendolino M , et al . New autoantigens in the antiphospholipid syndrome [J]. Autoimmun Rev , 2011 , 10 ( 10 ): 609 - 616 .

Cesarmanmaus G , RíosLuna N P , Deora A B , et al . Autoantibodies against the fibrinolytic receptor, annexin 2, in antiphospholipid syndrome [J]. Blood , 2006 , 107 ( 11 ): 4375 - 4382 .

Murthy V , Willis R , Romaypenabad Z , et al . Value of isolated IgA anti-β2-glycoprotein I positivity in the diagnosis of the antiphospholipid syndrome [J]. Arthritis Rheum , 2013 , 65 ( 12 ): 3186 - 3193 .

Otomo K , Atsumi T , Amengual O , et al . Efficacy of the antiphospholipid score for the diagnosis of antiphospholipid syndrome and its predictive value for thrombotic events [J]. Arthritis Rheum , 2012 , 64 ( 2 ): 504 - 512 .

Agmon-Levin N , Seguro L , Rosario C , et al . Anti-β2GPI-DI antibodies are a marker of APS severity [J]. Arthritis Rheum , 2013 , 65 ( S10 ): 1 .

Andreoli L , Nalli C , Borghi M O , et al . Domain I is the main specificity of anti-beta2 GP1 in systemic autoimmune diseases [J]. Arthritis Rheum , 2013 , 65 ( 10 ): S4 .

Zigon P , Perdan P K , Tomsic M , et al . Anti-phosphatidylserine/prothrombin antibodies are associated with adverse pregnancy outcomes [J]. J Immunol Res , 2015 , 2015 ( 7 ): 975704 .

Clark C A , Davidovits J , Spitzer K A , et al . The lupus anticoagulant: results from 2257 patients attending a high-risk pregnancy clinic [J]. Blood , 2013 , 122 ( 3 ): 341 - 347 .

Truglia S , Capozzi A , Mancuso S , et al . A monocentric cohort of obstetric seronegative anti-phospholipid syndrome [J]. Front Immunol , 2018 , 9 : 1678 - 1684 .

Zohoury N , Bertolaccini M L , Rodriguez-Garcia J L , et al . Closing the serological gap in the antiphospholipid syndrome: the value of “Non-criteria” antiphospholipid antibodies [J]. J Rheumatol , 2017 , 44 ( 11 ): 1597 - 1602 .

Ortona E , Capozzi A , Colasanti T , et al . Vimentin/cardiolipin complex as a new antigenic target of the antiphospholipid syndrome [J]. Blood , 2010 , 116 ( 16 ): 2960 - 2967 .

Espinosa G , Cervera R . Current treatment of antiphospholipid syndrome: lights and shadows [J]. Nat Rev Rheumatol , 2015 , 11 : 586 - 596 .

Practice Committee of the American Society for Reproductive . Medicine, evaluation and treatment of recurrent pregnancy loss: a committee opinion [J]. Fertil Steril , 2012 , 98 ( 5 ): 1103 - 1111 .

Miyakis S , Lockshin M D , Atsumi T , et al . International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS) [J]. J Thromb Haemost , 2006 , 4 ( 2 ): 295 - 306 .

中华人民共和国卫生部．中药新药临床研究指导原则 [M]．北京：中国医药科技出版社， 2002 ： 378-380，390-392 ．

李灿东，吴承玉．中医诊断学 [M]．北京：中国中医药出版社， 2012 ： 176-177，194 ．

中华医学会妇产科学分会产科学组．复发性流产诊治的专家共识 [J]．中华妇产科杂志， 2016 ， 51 ( 1 )： 3 - 9 ．

贺晶，蔡淑萍．妊娠合并干燥综合征对母胎的影响及妊娠期管理 [J]．中国实用妇科与产科杂志， 2016 ， 32 ( 10 )： 942 - 945 ．

Meroni P L , Borghi M O , Gross C , et al . Obstetric and vascular antiphospholipid syndrome: same antibodies but different diseases [J]. Nat Rev Rheumatol , 2018 , 14 : 433 - 440 .

Bramham K , Hunt B J , Germain S , et al . Pregnancy outcome in different clinical phenotypes of antiphospholipid syndrome [J]. Lupus , 2010 , 19 ( 1 ): 58 - 64 .

Laat B D , Groot P G D . Autoantibodies directed against domain I of beta2-glycoprotein I [J]. Curr Rheumatol Rep , 2011 , 13 ( 1 ): 70 - 76 .

Vlagea A , Gil A , Cuesta M V , et al . Antiphosphatidylserine/prothrombin antibodies (aPS/PT) as potential markers of antiphospholipid syndrome [J]. Clin Appl Thromb Hemost , 2013 , 19 ( 3 ): 289 - 296 .

杨桂云，王佩娟，贾晓斌，等． “补肾活血汤”对小鼠早期胚胎发育的作用 [J]．江苏中医， 2000 ， 21 ( 11 )： 50 - 51 ．

宋艳丽，孙自学，门波，等．滋肾健脾化瘀方对复发性流产患者凝血功能的影响 [J]．中国实验方剂学杂志， 2018 ， 24 ( 19 )： 195 - 200 ．

许璇璇，李玲孺，武彦伶，等．从表虚伏邪探讨玉屏风散双向免疫调节机制 [J]．安徽中医药大学学报， 2015 ， 34 ( 2 )： 1 - 3 ．

李淑贞，赵温利，曲迅，等．玉屏风口服液对免疫抑制小鼠免疫功能的调节作用 [J]．中成药， 1992 ， 14 ( 3 )： 26 - 27 ．

陈新，杨路，夏志道，等．加味玉屏风冲剂对手术患者免疫功能的调节作用 [J]．中国中医药信息杂志， 1998 ， 7 ( 5 )： 22-24，36 ．

Baigent C , Blackwell L , Collins R , et al . Aspirin in the primary and secondary preventation of vascular disease: collaborative Meta-analysisi of individual participant data from randomised tirals [J]. J Vasc Surg , 2010 , 373 ( 9678 ): 1849 - 1860 .

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玉屏风散加味联合阿司匹林干预RSA合并血清阴性APS及对D-二聚体，PagT的影响

Intervention of Modified Yupingfeng San Combined with Aspirin on D-dimer, PagT Levels of RSA with Seronegative APS

DOI：10.13422/j.cnki.syfjx.20191126

摘要

Abstract

关键词

Keywords

references