Multi-factor Analysis Of Drug Treatment Efficacy On Tubal Pregnancy And Spectrum-effect Relationship Of Hua Yu Xiao Zheng Herbal Compound Recipe

Ectopic pregnancy refers to the development of the implantation site outside the uterine cavity,of which almost 95%occurs in fallopian tubes,so,tubal pregnancy is the most common form.Ectopic pregnancy is a common acute abdomen in obstetrics and gynecology department,with the incidence about 2%.It is still one of the main causes of morbidity and mortality in early pregnancy.In recent years,the incidence of tubal pregnancy has been increasing year by year especially among the youth.It is extremely important to preserve fertility.With the development of diagnosis and treatment technology,tubal pregnancy has been discovered early,making drug therapy possible and providing a chance for more young patients to preserve reproductive function.In particular,the combination of Chinese and Western medicine can reduce the side effects while achieving the therapeutic effect.1 The clinical researchObjectiveBased on the previous research of diagnosis and treatment program of tubal pregnancy with traditional Chinese medicine and Western Medicine,a retrospective analysis was conducted to compare and analyze the cases of success drug treatment(no surgery)and failure(transferred to surgery)from the aspect of clinical effectiveness to find out factors leading to drug treatment failure,providing evidence for clinical application.Methods858 cases of patients with tubal pregnancy were analyzed by retrospective analysis,from the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2012 to June 2017.Based on clinical evaluation,all patients were divided into success group of 659 cases(77%,no surgery)and failure group 199 cases(23%,transferred to surgery).General clincal data of all patients were recorded,including age,menopause duration,vaginal bleeding days,tatal pregnancy times,delivery times,frequency of abortions or artificial abortions or spontaneous abortions history of cesarean section,frequency of ectopic pregnancy,with or without pelvic effusion,the degree of abdominal pain,history of abdominal surgery,human chorionic gonadotropin(?-HCG),progesterone(P),the maximum diameter of the mass by B-ultrasound,obesity,diabetes and other diseases combined,using single factor analysis and two classification logistic regression analysis to explore potential related factors that may lead to the failure of drug treatment of tubal pregnancy.Results(1)Cases included:according to diagnostic criteria,inclusion and exclusion criteria,858 cases of tubal pregnancy were collected from January 2012 to June 2017 and divided into 3 groups,460 cases with only Chinese medicine,173 cases with combination treatment with Chinese medicine and Western medicine,and 225 cases first with Chinese medicine and lately with the combination of Chinese medicine and Western medicine.(2)Results:?initial ?-HCG,degree of abdominal pain and frequency of artificial abortion are potential risk factors for drug treatment of tubal pregnancy;?high initial ?-HCG value is independent risk factor affecting drug treatment;?Other factors like ages,times of pregnancy and delivery,vaginal bleeding days,volume of pelvic effusion,the dimension of adnexal mass,etc.were not correlated with the success rate of conservative treatment.Conclusions(1)Patients with only Chinese medicine:?the single-factor analysis showed that factors including age,vaginal bleeding days,initial ?-HCG,intial P and frequency of abortions,had significant effect on the efficacy of drug treatment;?Multi-factor logistic regression analysis showed that the risk factor for drug treatment was initial ?-HCG.(2)Patients with the combination of Chinese medicine and western medicine:?The single-factor analysis showed that factors including menopause duraiton,vaginal bleeding days,intial ?-HCG,and history of pelvic inflammation and pelvic surgery,had significant effect on the efficacy of drug treatment;?multi-factor logistic regression analysis showed that the risk factors for drug treatment included initaol ?-HCG and the degree of abdominal pain.(3)Patients first with only Chinese medicine and lately with the combination of Chinese medicine and western medicine:?the single-factor analysis showed that factors including the degree of abdominal pain,initial ?-HCG,initial P,frequency of abortion and artificial abortion,and history of pelvic inflammation or pelvic surgery,had significant effect on the efficacy of drug treatment;?Multi-factor logistic regression analysis showed that the risk factor for drug treatment included initial ?-HCG,the degree of abdominal pain,and the frequency of artificial abortion.2 The experimental researchObjectiveBased on the previous research,it showed the effective substances of Huayu Xiaozheng recipe by using the conjoint analysis of high performance liquid chromatography mass spectrometry(HPLC-MS)and pharmacodynamics.Methods(1)Using uniform design scheme and 8 types of formula was designed based on 5 factors;(2)Using CCK-8 to assess the the growth inhibition of trophoblastic cells of Huayu Xiaozheng recipe;(3)Using high performance liquid phase mass spectrometry(HPLC-MS)to analyze 8 different formula respectively;(4)Using conjoint analysis of the results of pharmacodynamics and HPLC-MS of 8 formulas to obtain the possible effective substances preliminarily.Results(1)After 3 iterative regression analyses,the fitted regression equation was:inhibition rate=48.964+1.276×peachseed salvia miltiorrhiza-0.025 X peachseed salvia miltiorrhiza×peach kernel-0.08×peachseed salvia miltiorrhiza×radixarnebiae+0.036×trichosanthin2+0.054×radixarnebiae2.Ba sed on this regression equation,it could be figured out preliminarily that the optimized formulation of Huayu Xiaozheng recipe was peachseed salvia miltiorrhiza 20g,trichosanthin 20g,peach kernel 5g,and radix arnebiae 2g.(2)Under this experimental conditions,it was considered as effective substances with correlation coefficients between 0.3 and 1.0,so,the effective substances of Huayu XiaoZheng recipe included salvianolic acid B,cryptotanshinone,dihydrotanshinonI,albiflorin,amygdalin,gallic acid,benzoyl paeoniflorin and oxypaeoniflorin.Conclusion(1)Huayu XiaoZheng recipe could inhibit the growth of trophoblast cells,and based on the inhibition rate regression equation,it could be figured out preliminarily that the optimized formulation of Huayu Xiaozheng recipe was peachseed salvia miltiorrhiza 20g,trichosanthin 20g,peach kernel 5g,and radix arnebiae 2g.(2)Under this experimental conditions,the effective substances of Huayu XiaoZheng recipe was preliminarily considered as salvianolic acid B,cryptotanshinone,dihydrotanshinonI,albiflorin,amygdalin,gallic acid,benzoyl paeoniflorin and oxypaeoniflorin.