黄玉华 柯海 魏颖楠 郭婧 徐鸿燕 胡晶

摘要：目的 探討早期先兆流产患者中医证型的分布规律，分析其妊娠结局的相关因素。方法 纳入1010例早期先兆流产住院患者，采用Excel2010建立数据库，采集患者年龄、既往月经情况、流产次数、不良妊娠次数、发病节气、发病时孕周、中医证型及妊娠结局（出院时间≥3个月），分析中医证型的分布规律，以及影响妊娠结局的相关因素。结果 1010例患者中，肾虚证762例（75.4%），血热证178例（17.6%），气血虚弱证40例（4.0%），血瘀证15例（1.5%），肝郁证15例（1.5%）。不同证型在各年龄段、孕周间的分布差异有统计学意义（P<0.01），不同证型的既往月经情况、流产次数、不良妊娠次数、发病节气差异无统计学意义（P>0.05）。成功随访698例，其中妊娠成功567例（81.2%），妊娠失败131例（18.8%）。不同妊娠结局的年龄比较差异有统计学意义（P=0.026）。妊娠结局与年龄存在相关性（P=0.012，OR=1.063），与证型、流产次数、不良妊娠次数、既往月经情况、发病时孕周无明显相关性。结论 肾虚证为早期先兆流产最主要证型，证型分布与患者年龄段及发病时孕周有关，年龄是影响妊娠结局的相关因素。

关键词：早期先兆流产；中医证型；妊娠结局

DOI：10.3969/j.issn.1005-5304.2017.08.006

中图分类号：R271.942.1 文献标识码：A 文章编号：1005-5304（2017）08-0022-05

Analysis on the Distribution of TCM Syndromes and Related Factors of Pregnancy Outcome of 1010 Cases of Early Threatened Abortion HUANG Yu-hua1， KE Hai1， WEI Ying-nan1， GUO Jing1， XU Hong-yan1， HU Jing2 （1. Beijing Hospital of TCM Affiliated to Capital Medical University， Beijing 100010， China； 2. Beijing Research Institute of TCM， Beijing 100010， China）

Abstract： Objective To discuss the distribution laws of TCM syndromes of early threatened abortion； To analyze the related factors of pregnancy outcome of early threatened abortion. Methods The study included 1010 hospital patients who were diagnosed as early threatened abortion. Excel2010 was used to establish database in order to collect general information such as the age， menstrual history， times of abortion and adverse pregnancy， incidence of solar term and pregnancy week， the type of TCM syndromes and the pregnancy outcome （at least 3 months after being out of hospital） of patients. The distribution laws of TCM syndromes， and related factors of pregnancy outcome were analyzed. Results Among the 1010 cases， 762 cases were with kidney deficiency syndrome （75.4%）； followed by blood heat syndrome， a total of 178 cases， accounting for 17.6%； qi and blood deficiency syndrome， a total of 40 cases， accounting for 4%； blood stasis syndrome， a total of 15 cases， accounting for 1.5%； liver stagnation syndrome， a total of 15 cases， accounting for 1.5%. The distribution of TCM syndromes was statistical significance in the different age groups and the incidence of pregnancy week （P<0.01）. But there was no statistical significance in menstrual history， times of abortion， times of adverse pregnancy， and the incidence of solar term （P>0.05）. Among the 1010 cases， follow-up to 698 cases， 567 cases were successful pregnancies， accounting for 81.2% of the follow-up of patients； 131 cases were failed pregnancies， accounting for 18.8% of the follow-up of patients. In the study， it found

通讯作者：胡晶，E-mail：hujingebm@163.com

that there was statistical significance between different age groups and pregnancy outcomes （P=0.026）. The pregnancy outcomes were related to the age groups （P=0.012， OR=1.063）， and it was not related to TCM syndromes， times of abortion， times of adverse pregnancy， menstruation， pregnancy week. Conclusion Kidney deficiency syndrome is the main syndrome of early threatened abortion. The distribution of TCM syndromes is related to the age group and the incidence of pregnancy week of patients. Age of patients is the related factor affecting the pregnancy outcome.

Key words： early threatened abortion； TCM syndromes； pregnancy outcome

早期先兆流产指妊娠12周以内，出现阴道少量流血，或时下时止，或淋漓不断，持续数日或数周，无腹痛或有轻微下腹胀痛、腰痛及下腹坠胀感。经休息及治疗后病情好转，可继续妊娠；经治疗病情无好转，出血量多，腰腹痛加重，可发展为难免流产。先兆流产的发病率为10.0%～18.0%，其中65.0%～80.0%的自然流产发生在妊娠12周内[1]。早期先兆流产属中医学“胎漏”“胎动不安”范畴。《金匮要略·妇人妊娠病脉证并治》提出“妇人有漏下者，有半产后因续下血都不绝者，有妊娠下血者”，《脉经》首次记载“胎漏”之名。……