CN112870277B - 一种防治复发性流产的中药组合物 - Google Patents
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Abstract
本发明涉及中药复方技术领域,具体涉及一种防治复发性流产的中药组合物。所述用于防治复发性流产的中药组合物由以下药用原料制成:菟丝子25‑35份、桑寄生10‑20份、续断10‑20份、炒蒲黄8‑14份、人参8‑13份、陈皮7‑12份以及鸡血藤20‑35份,所述中药组合物的安全性高、便于提高安胎成功率,并可通过与其他药物联以提高临床疗效。
Description
技术领域
本发明涉及中药复方技术领域,尤其涉及一种防治复发性流产的中药组合物。
背景技术
一对夫妻多次发生的自然流产,为复发性流产(RSA)。我国将3次或3次以上在妊娠28周之前的胎儿丢失定义为RSA,同时提出应重视连续发生2次的流产并予评估。RSA在生育期女性中发病率约5%,是最常见的妊娠期并发症之一,其病因复杂,最近的生殖免疫研究表明,RSA的病因50%以上与免疫功能紊乱有关,与引起自身免疫性疾病的抗磷脂综合征(APS)关系最为密切。
抗磷脂综合征主要临床表现为复发性流产、动静脉血栓形成和血小板减少等,可产生抗磷脂抗体,包括狼疮抗凝物质(LA)、抗心磷脂抗体ACA、抗β2-糖蛋白Ⅰ抗体(anti-β2-GPⅠIgG)。所以磷脂抗体通过攻击供应胚胎营养的微循环血管,从而导致胚胎就因营养供应不足而死亡。
目前,抗磷脂综合征是唯一被证实与不良妊娠结局相关的导致血栓形成倾向的自身免疫型因素,也被认为是RSA病因中治疗最有意义的。APS的病理基础主要与血小板活化以及内皮细胞受损等有关。随着免疫性复发性流产日益受到广泛关注,西医学研究指出免疫性复发性流产的主要病因为血栓前状态,主要免疫学诊断为抗磷脂综合征,主要临床特征为动静脉血栓形成、病理妊娠(妊娠早期流产和中晚期死胎)和血小板计数减少。受APS影响的女性会产生一种或多种针对磷脂的抗磷脂抗体(aPL),是存在于滋养层中并在组织重塑时暴露于外表面抗体,还产生分子诸如狼疮抗凝蛋白、心磷脂、β2糖蛋白Ⅰ(β2GPI)、凝血酶原、膜联蛋白等。APS通常在患者怀孕和流产时首次出现,是主要的产科并发症,反复引发自然流产。机制方面,有人提出aPL诱导促凝表型,炎症似乎是导致APS患者胎盘损伤的必要因素,因为并非所有APS患者的妊娠都会导致并发症。早期的研究表明APS患者炎性反应异常,但是其具体机制尚不清楚。
目前,临床上对患有APS的RSA患者的治疗主要关注于如何预防血栓的形成。一般临床常用低分子肝素或阿司匹林治疗。然而,抗凝治疗只对部分患者有效,疗效较差且副作用较多。
发明内容
为解决上述技术问题,本发明的目的在于提供一种用于防治复发性流产的中药组合物,所述中药组合物的安全性高、便于提高安胎成功率,并可通过与其他药物联以提高临床疗效。
为达到上述技术效果,本发明采用了以下技术方案:
一种防治复发性流产的中药组合物,由以下药用原料制成:菟丝子、桑寄生、续断、炒蒲黄、人参、陈皮以及鸡血藤。
进一步地,所述防治复发性流产的中药组合物,由以下质量份数的药用原料制成:菟丝子25-35份、桑寄生10-20份、续断10-20份、炒蒲黄8-14份、人参8-13份、陈皮7-12份以及鸡血藤20-35份。
进一步地,所述防治复发性流产的中药组合物,由以下质量份数的药用原料制成:菟丝子30份、桑寄生15份、续断15份、炒蒲黄10份、人参10份、陈皮10份以及鸡血藤30份。
进一步地,所述防治复发性流产的中药组合物,其特征在于:所述中药组合物中还包括若干药学上可接受的辅料。
进一步地,所述防治复发性流产的中药组合物,其特征在于:所述中药组合物为汤剂、丸剂、片剂、胶囊剂、颗粒剂或者注射剂。
进一步地,所述汤剂的制备方法为:取配方中的中药饮片加水浸泡0.5 h-1h后,再连续煎煮3-5次,合并各次煎煮的滤液,得到该中药组合物的汤剂。
与现有技术相比,本发明的有益效果为:
本发明提供的一种用于防治复发性流产的中药组合物的以“补肾活血”为法,以菟丝子补肾益精,固冲安胎作为君药;桑寄生、续断补肝肾、固冲任,使胎气强壮;以炒蒲黄、鸡血藤以活血化瘀;加人参、陈皮以补气行气助活血之效。并通过临床验证,能够对抗磷脂综合征引起的复发性流产具有良好的防治效果,且该药物组合物的安全性高、制备方法简单、便于提高安胎成功率,并可通过与其他药物联以提高临床疗效,降低单一药物使用的不良反应发生率。
具体实施方式
以下实施例仅用于更加清楚地说明本发明的技术方案,因此只作为示例,而不能以此来限制本发明的保护范围。
实施例1
汤剂的制备:
配方:菟丝子30g、桑寄生15g、续断15g、炒蒲黄10g、人参10g、陈皮10g以及鸡血藤30g
制备方法:取配方中的中药饮片加水浸泡0.5 h-1h后,再连续煎煮3-5次,合并各次煎煮的滤液,将合并后的滤液浓缩至1200 ml,得到该中药组合物的汤剂。
实施例2
将上述实施例1中制备得到的汤剂进行浓缩后,加入一定的药用辅料,将其分别制备为丸剂、片剂、胶囊剂、颗粒剂以及注射剂。
实施例3
1资料与方法
1.1观察资料
将2017年3月-2019年12月在深圳市妇幼保健院中医科住院部住院安胎的先兆流产患者部分纳入临床实验,共纳入符合肾虚血瘀型抗磷脂综合征所致复发性流产患者138例,年龄在25-48岁之间,平均年龄为33.7岁;其中,既往自然流产次数2-8次,其中自然流产2次者82例,3次者37例,4次及以上者19例,平均流产次数2.64次。将上述所有患者随机分为观察组和对照组,组别间在年龄、孕次、自然流产次数等基线资料上差异无统计学意义(P>0.05),具有可比性。其中,观察组和对照组的具体资料见表1。
1.2纳入与排除标准
1.2.1纳入标准包括:
①符合APS所致复发性流产诊断标准,辨证属肾虚血瘀证;
②此次受孕为自然受孕或IVF-ET;
③年龄在20-48岁;
④卵泡期FSH≤10mIU/L;
⑤能够接受中药或免疫抑制剂治疗者。
其中,标准①中所述的APS所致复发性流产的诊断标准包括条件a、b以及c,具体地:
a.复发性流产(RSA)西医诊断标准:具有连续2次或2次以上自然流产;
b.抗磷脂综合征诊断标准:至少包括复发性流产或血栓栓塞中的一项临床症状以及同时具有一项抗磷脂抗体阳性实验室指标(抗磷脂抗体检测指标为:抗心磷脂抗体(ACA);抗β2GP-1 抗体;狼疮抗凝因子(LAC)。阳性诊断标准是指出现2 次以上抗磷脂抗体阳性,其间隔时间6周或以上)。
c.中医诊断标准(肾虚血瘀型免疫相关复发性流产)包括:
(a.)主症:①阴道少量流血;②小腹疼痛或坠胀;③腰酸胀痛;
(b.)次症:①精神倦怠;②头晕耳鸣;③夜尿频多;④眼眶暗黑或面部暗斑;⑤曾屡堕胎;
(c.)舌脉:舌暗,边尖有瘀点,苔薄白,脉沉滑或弦滑。
其中,具备以上主症2项以及次症2项或以上,结合舌脉,即可辨证为本证。
1.2.2排除标准包含:
①合并有子宫结构异常、先天性血栓前状态、内分泌功能异常;
②有严重药物过敏史者;
②有遗传因素如夫妇一方存在染色体异常所致复发性流产;
④有感染因素所致复发性流产。
2研究方法
2.1临床实验方法
观察组:服用实施例1中制备得到汤剂(用法用量为:每次一剂200 ml,一日二次,口服),联用低分子肝素钙(速碧林,葛兰素史克生产,批号:0.4ml:4100AXaIU 国药准字J20090005)皮下注射,一日一次。
对照组:单用低分子肝素钙进行治疗(速碧林,葛兰素史克生产,批号: 0.4ml:4100AXaIU 国药准字J20090005),皮下注射,一日一次。
2.2观察指标:
(1)主要观察指标
妊娠结局情况,包括孕12周安胎成功率、足月产、早产胎儿存活、流产、早产胎儿死亡等情况,结果见表3和表4;
(2)次要观察指标
①中医症候情况:对照治疗前后中医症候积分情况,结果见表5;
②免疫检查及凝血功能检测:治疗前后检测抗磷脂抗体及凝血功能:抗磷脂抗体指标包括狼疮抗凝物质(LA)、抗心磷脂抗体ACA、抗β2-糖蛋白Ⅰ抗体(anti-β2-GPⅠIgG);凝血纤溶指标包括:超敏D-二聚体(D-D)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB),结果见表6和表7。
2.3疗效评价方法:
2.3.1妊娠结局情况评定
评定安胎成功指标分成两部分:孕早期安胎成功标准以孕12周NT彩超结果提示宫内孕正常为孕早期安胎成功指标;孕晚期安胎成功标准以妊娠成功率=(足月产+早产胎儿存活)/(足月产+早产胎儿存活+流产+早产胎儿死亡)为孕晚期安胎成功指标。
2.3.2临床疗效评定标准参照中药新药临床研究指导原则修改制定
(1)痊愈:治疗后 5 天内阴道流血停止,小腹疼痛及腰酸胀痛等症消失,凝血-纤溶指标恢复正常、D-二聚体降至正常,妇科彩超检查示子宫大小、胚胎发育情况与孕周相符,证候积分减少大于95%,孕12 周时胎儿发育正常;
(2)显效:治疗 7 天阴道流血停止,小腹疼痛及腰酸胀痛等明显减轻,凝血-纤溶指标大部分改善、D-二聚体较前减轻,妇科彩超检查示子宫大小、胚胎发育情况与孕周相符,证候积分减少70%-95%,孕12 周时胎儿发育正常;
(3)有效:治疗后 10 天阴道流血停止,小腹隐痛及腰酸胀痛等症有所减轻, 凝血-纤溶指标有所改善、D-二聚体较前减轻,妇科彩超检查示子宫大小、胚胎发育情况与孕周基本相符,证候积分减少 30%-70%;
(4)无效:治疗后阴道流血超过 10 天未止,小腹疼痛及腰酸胀痛等症无减轻或有加重, 凝血-纤溶指标未改善或恶化、D-二聚体未减轻或升高,妇科彩超检查示子宫大小、胚胎发育情况与孕周基本相符或小于孕周,胚胎发育不良或停止发育,甚至发生难免流产证候积分减少小于 30%。
2.3.3中医疗效评定标准
中医证候疗效评价:根据症状量表评分,分别在治疗前及治疗后(孕12周)各评价一次,症状量表详见表2。
表2 症状量表
主症 | 0分 | 2分 | 3分 | 6分 |
自然堕胎史 | 无 | 2次 | 3次 | >> 4次 |
阴道出血量 | 无 | 时有时无,点滴而下 | 淋漓难净,量少 | 持续不净需用垫纸 |
出血色质 | 无 | 色淡紫,质薄 | 色淡暗,质清稀 | 色淡黯,如黑豆汁 |
小腹疼痛或坠胀 | 无 | 疼痛或坠胀时有时无 | 疼痛或坠胀持续存在 | 疼痛伴坠胀持续存在 |
腰酸胀痛 | 无 | 时有时无 | 不持续存在 | 持续存在 |
次症 | 0分 | 1分 | 2分 | 3分 |
两膝酸软 | 无 | 时有时无 | 持续存在 | 不欲行走 |
神疲肢倦 | 无 | 时有时无 | 持续存在 | 懒于行动 |
头晕耳鸣 | 无 | 偶有出现 | 时有时无 | 频繁出现 |
夜尿频多 | 无 | 1次 | 2次 | >> 3次 |
眼眶暗黑或面部暗斑 | 无 | 暗淡 | 灰黑 | 暗黑 |
其中,病情分度:中医症候积分积分≤15分为轻度,16-30分为中度,≥31分为重度。
根据《中药新药临床研究指导原则》修改制定(疗效指数(n)=[(治疗前积分—治疗后积分)/治疗前积分]×100%):
痊愈:治疗后各症状消失,证候积分值减少≥95%;
显效:治疗后各症状明显减轻,证候积分值减少≥70%,<95%;
有效:治疗后各症状有所减轻,证候积分值减少≥30%,<70%;
无效:治疗后各症状无减轻或有加重,证候积分值减少<30%。
2.3.4安全性观察指标
治疗前后分别检测四测及血、尿常规、肝功能、肾功能、心电图;记录用药后不良反应:临床上需密切观察受试者可能出现的不良反应,如阴道出血突然增多、肝功能异常、过敏反应、血小板减少、骨质疏松等,并详细记录,评估与临床用药的相关性,结果见表8。
2.4统计学方法
采用SPSS 25.0进行数据统计分析,计量资料以表示,组间比较采用成组t 检验,治疗前后比较采用配对t检验;计数资料用百分比表示,组间比较采用卡方检验,p<0.05表示差异有统计学意义,P<0.01表示差异有显著统计学意义。
3.研究结果
3.1 观察组和对照组RSA患者妊娠结局比较,结果见表3
表3 观察组和对照组RSA患者妊娠结局比较(例)
治疗后,观察组孕早期安胎成功率为89.86%,孕晚期安胎成功率为84.06%;对照组孕早期安胎成功率为68.12%,孕晚期安胎成功率为57.97%。观察组安胎成功率显著高于对照组,差异有统计学意义(P<0.01)。
3.2观察组和对照组RSA患者临床疗效比较
治疗后,观察组有效率91.30%,对照组有效率71.01%,观察组总有效率显著高于对照组,差异有统计学意义(P<0.01),结果见表4。
表4 观察组和对照组治疗后临床疗效分级比较(例)
3.3 观察组和对照组治疗后中医症候改善情况比较
观察组治疗前后中医证候积分经配对t检验,差异有统计学意义(P<0.01),对照组治疗前后的差异有统计学意义(P<0.01),提示观察组和对照组治疗均有疗效。治疗后观察组干预效果优于对照组,差异有统计学意义(P<0.01),提示安子调冲汤联合肝素在改善中医证候上优于单独使用肝素。结果见表5。
3.4 观察组和对照组RSA患者抗磷脂抗体转阴率比较
观察组治疗后抗磷脂抗体转阴率为91.30%,对照组治疗后抗磷脂抗体转阴率为75.36%,观察组和对照组治疗后抗体转阴情况经检验,差异有统计学意义(P<0.05)。结果见表6。
表6 观察组和对照组RSA患者抗磷脂抗体转阴率比较(例)
组别 | n | ACA+ | LA+ | Anti-β2-GPⅠIgG+ | 抗体转阴 | 转阴率% | <i>P</i> | |
观察组 | 69 | 31 | 18 | 20 | 63 | 91.30 | 6.313 | 0.012 |
对照组 | 69 | 30 | 21 | 18 | 52 | 75.36 |
3.5 观察组和对照组治疗前后凝血-纤溶指标比较
经治疗后,经配对t检验,观察组与对照组凝血-纤溶指标均较前改善,PT、APTT较前增加,观察组升高程度较对照组更大,差异有统计学意义(P<0.05),FIB、D-D较前下降,观察组较对照组降低程度更大,差异有统计学意义(P<0.01),提示观察组和对照组治疗后高凝状态均有改善,且治疗后观察组干预效果优于对照组。结果见表7。
注:P为治疗后观察组与对照组组间比较。
3.6 观察组和对照组治疗后不良反应比较
观察组和对照组治疗后出现不良反应,诸如阴道出血突然增多、肝功能异常、过敏反应、血小板减少、骨质疏松等。观察组出现1例阴道出血突然增多、1例肝功能异常,对照组出现3例阴道流血增多,4例肝功能异常,5例出现皮肤过敏反应,观察组和对照组均未见血小板减少及骨质疏松。观察组不良反应发生率为2.90%,对照组不良反应发生率为17.39%,可知观察组较对照组发生不良反应少、安全性更高。详见表8。
表8 观察组和对照组治疗后不良反应比较
妊娠结局比较方面,观察组孕早期安胎成功率为89.86%,孕晚期安胎成功率为84.06%;对照组孕早期安胎成功率为68.12%,孕晚期安胎成功率为57.97%,观察组安胎成功率显著高于对照组(P<0.01)。临床疗效比较方面,观察组有效率91.30%,对照组有效率71.01%,观察组总有效率显著高于对照组(P<0.01);中医症候改善情况,治疗后观察组干预效果优于对照组(P<0.01),尤其在改善阴道流血、小腹隐痛及腰酸胀痛症状方面由于对照组。观察组治疗后抗磷脂抗体转阴率为91.30%,对照组治疗后抗磷脂抗体转阴率为75.36%,观察组治疗后抗体转阴高于对照组(P<0.05)。同时,还发现观察组6例抗体未转阴者复查D-二聚体仍偏高,且均发生早期流产。观察组和对照组凝血-纤溶指标均较治疗前改善,PT、APTT较前增加,观察组升高程度较对照组更大,差异有统计学意义(P<0.05),FIB、D-D较前下降,观察组较对照组降低程度更大(P<0.01),提示观察组和对照组治疗后高凝状态均有改善,且治疗后观察组干预效果优于对照组。安全性方面,观察组出现1例阴道出血突然增多、1例肝功能异常,不良反应发生率为2.90%,对照组出现3例阴道流血增多,4例肝功能异常,5例出现皮肤过敏反应,不良反应发生率为17.39%,观察组较对照组发生不良反应少、安全性更高。
综上所述,安子调冲汤联合低分子肝素钙治疗复发性流产合并抗磷脂综合征疗效显著,可提高安胎成功率和临床疗效,降低中医症候积分,增加抗磷脂抗体转阴率,改善凝血-纤溶指标,且安全性高,应尽早应用。
以上实施例仅用以说明本发明的技术方案而非限制,尽管参照较佳实施例对本发明进行了详细说明,本领域的普通技术人员应当理解,可以对本发明的技术方案进行修改或者等同替换,而不脱离本发明技术方案的宗旨和范围,其均应涵盖在本发明的权利要求范围当中。本发明未详细描述的技术、形状、构造部分均为公知技术。
Claims (4)
1.一种防治复发性流产的中药组合物,其特征在于,由以下质量份数的药用原料制成:菟丝子30份、桑寄生15份、续断15份、炒蒲黄10份、人参10份、陈皮10份以及鸡血藤30份。
2.如权利要求1所述的一种防治复发性流产的中药组合物,其特征在于:所述中药组合物中还包括若干药学上可接受的辅料。
3.如权利要求1所述的一种防治复发性流产的中药组合物,其特征在于:所述中药组合物为汤剂、丸剂、片剂、胶囊剂、颗粒剂或者注射剂。
4.如权利要求3所述的一种防治复发性流产的中药组合物的制备方法,其特征在于,所述汤剂的制备方法为:取配方中的中药饮片加水浸泡0.5 h-1h后,再连续煎煮3-5次,合并各次煎煮的滤液,得到该中药组合物的汤剂。
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