林超 章国晶 陈湘宜 张虹 周熹 陈祥艳 孙云

[摘要] 目的 觀察丹益活血汤对不同孕期的APS相关复发性流产患者的临床效果。 方法 回顾性分析2018年11月至2019年12月在温州市中医院收治的APS相关复发性流产患者60例，其中把孕龄1～13周的作为早孕组，把孕龄14～27周的作为中孕组，每组各30例。两组均采用中药治疗，服用由温州市煎药中心统一煎制的丹益活血汤加减中药汤剂口服治疗，200 mL口服，每日2次。观察两组活产率以及活产时胎儿出生体重、活产胎儿身长、新生儿APGAR评分;干预前及干预8周后的血小板聚集率、D-二聚体、蛋白S活性。 结果 早孕组产妇活产率为86.67%，高于中孕组的73.33%，差异有统计学意义（P<0.05）;而早孕组在活产时胎儿出生体重、身长、Apgar评分同样高于中孕组，差异有统计学意义（P<0.05）。干预后，早孕组和中孕组在所有指标均高于干预前，差异有统计学意义（P<0.05）。而组间比较，早孕组在血小板聚集率、D-二聚体、蛋白S活性优于中孕组，差异有统计学意义（P<0.05）。 结论 在孕早期使用丹益活血汤，比孕中期使用该方，能够更加有效的改善患者的凝血状态，降低血栓发生的风险，从而提高APS相关的复发性流产患者的活产率，保证胎儿的健康情况，值得进一步推广和应用。

[关键词] 丹益活血汤;抗磷脂综合征;复发性流产;不同孕期

[中图分类号] R714.21          [文献标识码] B          [文章编号] 1673-9701（2021）35-0142-04

Comparative study of Danyi Huoxue Decoction on APS-related recurrent abortion patients during different gestational periods

LIN Chao1   ZHANG Guojing2   CHEN Xiangyi1   ZHANG Hong1   ZHOU Xi1   CHEN Xiangyan1   SUN Yun1

1.Department of Gynecology， Wenzhou Traditional Chinese Medicine Hospital in Zhejiang Province， Wenzhou   325000， China; 2.Department of Oncology， Wenzhou Geriatric Hospital in Zhejiang Province， Wenzhou   325000， China

[Abstract] Objective To observe the clinical efficacy of Danyi Huoxue Decoction on APS-related recurrent abortion patients during different gestational periods. Methods A total of 60 patients with APS-related recurrent abortion admitted to Wenzhou Traditional Chinese Medicine Hospital from November 2018 to December 2019 were analyzed retrospectively. They were divided into the early pregnancy group（with 1-13 weeks of gestation， n=30） and the middle pregnancy group （with 14-27 weeks of gestation， n=30）. Both groups were treated with traditional Chinese medicine， taking Danyi Huoxue Decoction prepared by Wenzhou Decoction Center， 200 ml orally， twice a day. The live birth rate， fetal birth weight， fetal length and APGAR score of neonates were observed in the two groups. Platelet aggregation rate， D-dimer and protein S activity before and 8 weeks after intervention were observed as well. Results The live birth rate in the early pregnancy group was 86.67%， which was superior to 73.33% in the middle pregnancy group， with statistically significant difference （P<0.05）. However， the fetal birth weight， fetal length and Apgar score of the early pregnancy group were also superior to those of the middle pregnancy group， with statistically significant differences （P<0.05）. After intervention， all indices of the early pregnancy group and the middle pregnancy group were superior to those before intervention， with statistically significant differences（P<0.05）. Meanwhile， when it was compared between groups， the platelet aggregation rate， D-dimer and protein S activity in the early pregnancy group were better than those in the middle pregnancy group， with statistically significant differences （P<0.05）. Conclusion Danyi Huoxue Decoction used in early pregnancy period can more effectively improve the coagulation state of patients and reduce the risk of thrombosis than used in middle pregnancy period， thus improving the living rate of APS-related recurrent abortion patients and ensuring the health of fetus. Therefore， it is worthy of further promotion and application.

[Key words] Danyi Huoxue Decoction; Antiphospholipid syndrome; Recurrent abortion; Different gestational periods

抗磷脂综合征（Antiphospholipid syndrome，APS）是由抗磷脂抗体（Antiphospholipid antibodies，APL）引起的一种自身免疫性疾病，临床上以反复动静脉血栓、习惯性流产以及系统性红斑狼疮为主要表现[1]。国内研究报道[2]，APS患者发生病理妊娠的概率为51%～68.4%，主要表现为胎死宫内和复发性流产。……