| Recurrent spontaneous abortion (RSA) is a common and frequent disease, there are many complicated causes, The more definite western medicine etiology are genetic factors, anatomical factors, endocrine factors, immunological factors and infective factors. The recurrent spontaneous abortion often can be avoided by right diagnoses and therapies. At present, western medicine treatments do not make progress so much at home and abroad, new effective therapies are absence. The Chinese medicine treatments of RSA are common and more effective, but in the Chinese medicine community, there are different points about Chinese medicine pattern of RSA, there is not generally accepted and authoritative standard of diagnoses and therapies. In order to carry forward the advantages of Chinese medicine treatment and improve efficacy, it is necessary to study on correlation between western medicine etiology and Chinese medicine pattern of recurrent spontaneous abortion, summarize the western medicine diagnosis by differentiation of diseases and causes corresponding relation with Chinese medicine pattern by differentiation of symptoms. Expect to establish standard appraisal system of Chinese medicine normative symptom and pattern according to western medicine etiology classified, sum up the corresponding formula based on syndrome differentiation and treatment.PART:I The study on correlation between western medicine etiology and Chinese medicine syndrome pattern of recurrent spontaneous abortionObjective: To learn the common western medicine etiologies and Chinese medicine patterns of recurrent spontaneous abortion, discuss the correlation between western medicine etiology and Chinese medicine pattern of recurrent spontaneous abortion, summarize the western medicine diagnosis by differentiation of diseases and causes corresponding relation with Chinese medicine pattern by differentiation of symptoms, expect to establish standard appraisal system of Chinese medicine normative symptom and pattern according to western medicine etiology classified.Methods: During2009to2012periods, some outpatients recurrent spontaneous abortion patients, according to inclusion criteria and exclusion criteria,386patients are collected,312persons are not in gestation period and74persons are in gestation period, who are detected the related parameters of western medicine etiology and gathered Chinese medicine symptoms to score and discriminate based on questionnaires. To calculate the percentage of western medicine etiology and Chinese medicine pattern of RSA, conclude the common western medicine etiology and Chinese medicine pattern of RSA, and discuss the correlation between western medicine etiologies and Chinese medicine pattern of RSA, summarize the western medicine diagnosis by differentiation of diseases and causes corresponding relation with Chinese medicine pattern by differentiation of symptoms.Results:(1) The common Chinese medicine pattern of RSA patients are kidney deficiency, deficiency of spleen and kidney, kidney deficiency and blood stasis in turn,the percentage respectively are65.5%,15%,10.9%;the percentage of kidney deficiency in the gestation RSA patients is85.1%,in the not gestation RSA patients is60.9%, there are statistical differences compare two groups(P＜0.001), kidney deficiency is positively correlated with gestation(OR=3.678); the percentage of deficiency of spleen and kidney in the gestation RSA patients is6.8%, in the not gestation RSA patients is17%, there are statistical differences compare two groups(P=0.027),(deficiency of spleen and kidney is negatively correlated with gestation(OR=0.354).(2) The common western medicine etiology of RSA patients are blocking antibody deficiency, endocrine abnormal, genital tract infection in turn,the percentage respectively are96.08%,66.57%,37.63%.(3)The percentage of kidney deficiency in all endocrine abnormal RSA patients is66.2%,in the endocrine normal RSA patients is64.7%, there are not statistical differences compare two groups(P=0.77);In all endocrine abnormal RSA patients not in gestation period,the common Chinese symptoms are soreness of waist, god exhausting the limb tired, the percentage respectively are74.1%,67.9%.(4) The percentage of kidney deficiency in the androgen excess RSA patients is75.5%, in the androgen normal RSA patients is62.3%, there are statistical differences compare two groups(P=0.021), androgen excess is positively correlated with kidney deficiency (OR=1.868); In the androgen excess RSA patients not in gestation period, the common Chinese symptoms are soreness of waist, god exhausting the limb tired, lusterless complexion, the percentage respectively are70.6%,62.7%,51%.(5) The percentage of asthenia of qi and blood in hyperprolactinemia RSA patients is21.7%,in the prolactin normal RSA patients is4.7%, there are statistical differences compare two groups(P=0.001), hyperprolactinemia is positively correlated with asthenia of qi and blood(OR=5.685); In the hyperprolactinemia RSA patients not in gestation period, the percentage of kidney deficiency, asthenia of qi and blood respectively are40.9%,22.7%, in the prolactin normal RSA patients respectively are62.2%,4.8%, asthenia of qi and blood has significant differences compare two groups(P=0.001),hyperprolactinemia not in gestation period is positively correlated with asthenia of qi and blood(OR=5.809); In the hyperprolactinemia RSA patients not in gestation period, the common Chinese symptoms are soreness of waist, lusterless complexion, be flustered and shortness of breath, the percentage respectively are72.7%,63.6%,59.1%.(6) The percentage of kidney deficiency in the high insulin RSA patients is58.3%, in the insulin normal RSA patients is66.4%, there are not statistical differences compare two groups(P=0.424); In the high insulin RSA patients not in gestation period, the common Chinese symptoms are soreness of waist, God exhausting the limb tired, be flustered and shortness of breath, the percentage respectively are73.9%,69.6%,60.9%.(7) The percentage of kidney deficiency in the elevated FSH RSA patients not in gestation period is61.4%%, in the FSH normal RSA patients is60.1%, there are not statistical differences compare two groups(P=0.835); In the elevated FSH RSA patients not in gestation period, the common Chinese symptoms are soreness of waist, mouth dryness, two knees weakness, the percentage respectively are79.5%,63.9%,48.2%, the percentage in the FSH normal RSA patients respectively are71.3%,55.3%,35.1%, two knees weakness has significant differences compare two groups(P=0.042), elevated FSH not in gestation period is positively correlated with two knees weakness(OR=1.72).(8) The percentage of kidney deficiency in the luteal phase deficiency RSA patients is72.4%, in the luteal function normal RSA patients is64.2%, there are not statistical differences compare two groups(P=0.232);In the luteal phase deficiency RSA patients not in gestation period, the percentage of kidney deficiency and blood heat respectively are50%and25%, in the luteal function normal RSA patients respectively are60.8%and5%, blood heat has significant differences compare two groups(P=0.004), luteal phase deficiency not in gestation period is positively correlated with blood heat(OR=6.333); In the luteal phase deficiency RSA patients not in gestation period, the common Chinese symptoms are mouth dryness, upset less sleep, god exhausting the limb tired, soreness of waist, the percentage respectively are83.3%,75%,75%,66.7%.(9) The percentage of kidney deficiency in the blocking antibody deficiency RSA patients is63.3%, in the blocking antibody normal RSA patients is61.5%, there are not statistical differences compare two groups(P=0.896); In the blocking antibody deficiency RSA patients not in gestation period, the common Chinese symptoms are soreness of waist, god exhausting the limb tired, the percentage respectively are74.1%,63.5%.(10) The percentage of kidney deficiency and Kidney blood stasis in the positive anti-phospholipid antibody RSA patients respectively are66.7%and20%, in the negative anti-phospholipid antibody RSA patients respectively64.1%and11.7%, there are not statistical differences compare two groups(P=0.838,0.332); In the positive anti-phospholipid antibody RSA patients not in gestation period, the common Chinese symptoms are soreness of waist, god exhausting the limb tired, the lower abdomen pain, the percentage respectively are100%,78.6%,64.3%, in the negative anti-phospholipid antibody RSA patients, the percentage respectively are73.5%,63.6%,50.9%, soreness of waist has significant differences compare two groups(P=0.026), positive anti-phospholipid antibody not in gestation period is positively correlated with soreness of waist (OR=1.067);(11) The percentage of kidney deficiency and hot and humid deposition in the ABO incompatibility RSA patients respectively are62.2%,18.9%, in the blood type antibody negative RSA patients respectively65.6%and0.3%, hot and humid deposition has significant differences compare two groups(P<0.0001), ABO incompatibility is positively correlated with soreness of waist (OR=75.833); In the ABO incompatibility RSA patients not in gestation period, the percentage of kidney deficiency, spleen and kidney deficiency and hot and humid deposition respectively are56.3%,21.9%and12.5%, in the blood type antibody negative RSA patients respectively are61.9%,15.9%and0.4%, hot and humid deposition has significant differences compare two groups(P<0.0001), ABO incompatibility not in gestation period is positively correlated with soreness of waist (OR=38.429); In the ABO incompatibility RSA patients not in gestation period, the common Chinese symptoms are soreness of waist, god exhausting the limb tired and mouth dryness, the percentage respectively are71.9%,71.9%and78.1%, in the blood type antibody negative RSA patients respectively are73.7%,63.3%and55.6%, mouth dryness has significant differences compare two groups(P=0.014), ABO incompatibility not in gestation period is positively correlated with mouth dryness (OR=2.857).(12) In the TORCH infection RSA patients,the percentage of kidney deficiency, deficiency of spleen and kidney,respectively are52%,20%, in the not TORCH infection RSA patients respectively are65.4%,15.1, there are not statistical differences compare two groups(P=0.176,0.516); In the TORCH infection RSA patients not in gestation period, the common Chinese symptoms are soreness of waist, god exhausting the limb tired, the percentage respectively are71.4%,61.9%.(13) In the genital tract infection RSA patients,the percentage of kidney deficiency is60.4%, in the not genital tract infection RSA patients is65.2%, there are not statistical differences compare two groups(P=0.402); In the genital tract infection RSA patients not in gestation period, the common Chinese symptoms are soreness of waist, god exhausting the limb tired, mouth dryness, lusterless complexion, two knees weakness, the percentage respectively are79.8%,69.2%,62.5%,51.9%,50%, in the not genital tract infection RSA patients, the percentage respectively are69.2%,67.5%,56.6%,47.6%,32.9%, two knees weakness has significant differences compare two groups(P=0.007), tract infection not in gestation period is positively correlated with mouth dryness (OR=2.043).Conclusions:(1) The most common Chinese medicine pattern of recurrent spontaneous abortion is kidney deficiency, it run through all western medicine etiologies. In gestation period, kidney deficiency is more common; in not gestation period, deficiency of spleen and kidney is more common.(2) The common western medicine etiologies of recurrent spontaneous abortion is kidney deficiency are patients are blocking antibody deficiency, endocrine abnormal, genital tract infection in turn.(3) Comparing with the western medicine etiology normal RSA patients, Qi and blood deficiency is more common in hyperprolactinaemic patients, blood heat is more common in luteal phase deficiency patients, hot and humid deposition is more common in ABO incompatibility patients, and speculate that in not gestation period positive anti-phospholipid antibody may be correlated with kidney deficiency and blood stasis, elevated FSH and genital tract infection may be correlated with kidney deficiency. It is necessary to enlarge sample to study and discuss the correlation between western medicine etiologies and TCM syndrome types of RSA.PART II:The effect of Tonifying-kidney Formula on recurrent spontaneous abortionObjective: To compare the effective and success rate of preventing abortion of Tonifying-kidney formula plus progesterone therapy and progesterone alone therapy on patients who have medical history of recurrent spontaneous abortion, and analyse the efficacy of Tonifying-kidney formula, in order to supply a more effective scheme of combination of Chinese traditional and western medicine for recurrent spontaneous abortion.Methods: In our hospital on the base of inclusion criteria and exclusion criteria,153outpatients are collected, who are early pregnancy patients with low progesterone level and blocking antibody deficiency, Tonifying-kidney formula plus progesterone treatment group(A group) have72persons and progesterone alone treatment group(B group) have81persons, two groups are taken the corresponding formula,tablets or injection.Regular follow up progesterone level, adverse reaction after taking medicines, monitor embryonic or fetal development situation through B ultrasound.Results:(1) After treatment,the success rate of preventing abortion of A group is70.8%,B group is53.1%, there are statistical differences (P=0.024)(2) The rate of preventing abortion of A group is90.3%,B group is75.3%, there are statistical differences (P=0.015);(3) On the time of gestation ages12,20,28,37weeks, the fetal survival rate of A groups respectively are87.5%,83.3%,76.4%,70.8%, the fetal survival rate of B groups on the above gestation ages respectively are74.1%,64.2%,60.5%,50.6%, there are statistical differences compare two groups (P=0.037,0.008,0.035,0.011); On the time of gestation ages7,9weeks, the fetal survival rate of A groups respectively are 97.2%,94.4%, the fetal survival rate of B groups respectively are98.8%,92.6%, there are not statistical differences compare two groups (P=0.492,0.644).Conclusions:Both on the effective rate and the success rate of preventing abortion, Tonifying-kidney formula plus progesterone treatment group is more excellent than progesterone alone treatment group to prevent recurrent spontaneous abortion,and on the different gestation ages at12,20,28,37weeks, Tonifying-kidney formula plus progesterone treatment group have higher level fetal survival rate than progesterone alone treatment group, but on the gestation ages at7,9weeks, fetal survival rate has not significant difference compare two group. |
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