| Objective 1.To investigate the distribution of etiology and TCM constitution in 692 patients with recurrent miscarriage through retrospective study.2.To evaluate the clinical efficacy of Bushen Huoxue Recipe by observing the changes of related indicators and pregnancy in patients with antiphospholipid antibody-positive recurrent miscarriage before and after treatment with Bushen Huoxue Chinese medicine combined with aspirin,so as to provide clinical evidence for Bushen Huoxue Recipe for the prevention and treatment of antiphospholipid antibodypositive recurrent miscarriage.in accordance with.Methods 1.The etiology and TCM constitution results of 692 patients with recurrent miscarriage who were treated in the Department of Reproductive Immunology,Zhejiang Litongde Hospital from September 2019 to September 2021 were collected,and the distribution of etiology and TCM constitution was analyzed.2.A total of 88 patients with antiphospholipid antibody positive recurrent miscarriage who were treated in the Reproductive Immunity Department of Litongde Hospital of Zhejiang Province during the same period were included.According to the random number table method,they were divided into a treatment group of 44 cases and a control group of 44 cases.The control group was treated with low-dose aspirin,and the treatment group was treated with aspirin entericcoated tablets and traditional Chinese medicine for invigorating the kidney and activating blood,for a total of 3 menstrual cycles.The coagulation function,Ddimer,thromboelastometry,uterine artery blood flow resistance and early pregnancy success rate in the treatment group and control group before and after treatment were observed.Results 1.The etiology of 692 recurrent miscarriage patients included in this study were immune factors,infectious factors,endocrine factors,prethrombotic state,anatomical structural factors and genetic factors,which were 39.31%,34.68%,31.07%,19.08%,18.35%and 3.90%.2.The immune factors were lymphocyte subsets,anti-thyroid antibodies,antinuclear antibodies,anti-phospholipid antibodies,anti-sperm antibodies,antiendometrial antibodies and anti-ovarian antibodies,which were 44.08%,19.51%,16.33%,and 13.29%,respectively.,10.40%,3.47%and 3.18%.3.The infection factors were mycoplasma infection,bacterial infection,HPV infection and chlamydia infection,which were 26.45%,6.79%,6.07%and 0.72%,respectively.4.Endocrine factors were insulin resistance,thyroid disease,impaired glucose tolerance,polycystic ovary syndrome and hyperprolactinemia,which were 27.02%,16.04%,7.80%,1.73%and 1.73%,respectively.5.The indicators of prethrombotic state were homocysteine,antiphospholipid antibody and D-dimer,which were 13.73%,13.29%and 4.42%,respectively.6.Anatomical structural factors were intrauterine adhesions,uterine fibroids,adenomyosis,uterine congenital malformation and cervical insufficiency,which were 10.69%,10.55%,2.6%,2.31%and 1.3%,respectively.7.Chromosomal abnormalities accounted for 3.90%of the total population.8.The TCM constitutions of the 530 patients with recurrent miscarriage included in this study were in turn biased constitution and peaceful constitution,accounting for 83.58%and 16.42%,respectively.Among them,36.23%of patients with a single biased constitution,15.28%of patients with two constitution types,and 32.08%of patients with three constitution types.9.The patients with a single biased TCM constitution were yang deficiency,yin deficiency,qi stagnation,damp-heat,qi deficiency,blood stasis,phlegmdampness and special constitution,respectively 16.23%,5.28%,3.77%,3.40%,2.83%,1.51%,3.18%and 1.13%.10.The patients with two TCM constitutions were 3.40%,2.26%and 1.89%,respectively.11.The patients with three TCM constitutions were yang deficiency with qi deficiency and qi stagnation,yang deficiency with phlegm-dampness and dampheat,and yang deficiency with qi deficiency and damp-heat,which were 3.77%,2.64%and 2.45%,respectively.12.There were significant differences in APTT and PT between the treatment group and the control group before and after treatment(P<0.05).There was no significant difference in APTT and PT between the two groups after treatment(P>0.05).There was no significant difference in TT and FIB between the treatment group and the control group before and after treatment(P>0.05).There were significant differences in D-D between the treatment group and the control group before and after treatment(P<0.05),and there were significant differences in D-D between the two groups after treatment(P<0.05).13.There were significant differences in R value and MA between the treatment group and the control group before and after treatment(P<0.05).After treatment,there was a significant difference in R value between the two groups(P<0.05).There was no significant difference in MA between the two groups after treatment(P<0.05).There were significant differences in a angle and K value in the treatment group after treatment(P<0.05),but there was no significant difference in a angle and K value in the control group after treatment(P>0.05).14.There were significant differences in S/D,RI and PI between the treatment group and the control group before and after treatment(P<0.05),and there were significant differences in S/D,RI and PI between the two groups after treatment(P<0.05).15.After treatment,the success rate of early pregnancy in the treatment group was 69.8%,while that in the control group was 45%.There was a significant difference in the success rate of early pregnancy between the two groups(P<0.05).Conclusion 1.The common causes of recurrent miscarriage are immune factors,infectious factors,endocrine factors and prothrombotic state.The common immune factors are abnormal lymphocyte subsets,abnormal anti-thyroid antibodies and abnormal anti-nuclear antibodies.Common infectious factors are mycoplasma infection,bacterial infection and HPV infection.Common endocrine factors are insulin resistance,thyroid disease,and impaired glucose tolerance.Common abnormal markers of a prothrombotic state are homocysteine and antiphospholipid antibodies.2.Most of the TCM constitutions of patients with recurrent miscarriage are biased and combined,and the susceptible constitutions include yang deficiency,yin deficiency and qi stagnation.3.The use of Bushen Huoxue Recipe before pregnancy can shorten the D-D of patients with antiphospholipid antibody positive recurrent miscarriage,and reduce the S/D,RI and PI values of uterine artery blood flow and improve the success rate of early pregnancy. |
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