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复发性流产是临床妇科常见病，严重影响着女性生殖健康，给社会及家庭带来沉重负担及痛苦。复发性流产的病因较为复杂，除已明确的遗传、解剖、感染及内分泌等因素外，尚有部分原因不明，称之为不明原因复发性流产，约占复发性流产的40%。目前，临床上已有大量研究对不明原因复发性流产患者的治疗方法进行探索，研究显示中西医治疗均具有一定的临床应用效果。西医临床主要包括免疫治疗、免疫抑制治疗、抗凝治疗、孕激素治疗等。总结导师经验的基础并结合多年临床实践，笔者以为本病中医病机主要在冲任受损，脾气虚弱，气血亏虚，不能摄精成孕以养胎；肾气不足，血行迟滞，血瘀胞脉无以养胎。临证以补肾健脾养血，活血化瘀通络为基本治则，口服中药配合针灸外治，提高妊娠率。本文对国内外治疗不明原因复发性流产的方法进行综述，以期为临床提供参考。
Abstract：Recurrent spontaneous abortion is a common disease in gynecology,and it seriously affects women's reproductive health and brings heavy burden and pain to society and families. The cause of recurrent spontaneous abortion is complicated,in addition to the well-defined genetic,anatomical,infection and endocrine factors,and there are still some unknown causes,which is called as unexplained recurrent spontaneous abortion,accounting for 40% of recurrent abortion. At present,there are a lot of researches on the treatment methods of the patients with the unexplained recurrent spontaneous abortion,which also shows that the treatments of traditional Chinese and Western medicine all have certain clinical application effect. Western medicine clinical methods mainly include immunotherapy,immunosuppressive therapy,anticoagulation therapy,progesterone therapy,etc. Based on the experience of our professor and combined with many years of clinical practice,the author believes that the pathogenesis of this disease in traditional Chinese medicine is mainly due to impaired impulse and deficiency of spleen,lack of Qi and blood,which cannot nourish the fetus;deficiency of kidney Qi,delayed blood flow,and blood stasis which could not raise the fetus. Clinical treatment is based on invigorating the kidney,tonifying spleen and nourishing blood,promoting blood circulation to remove blood stasis and dredge collaterals. Oral Chinese medicine combined with external acupuncture and moxibustion has achieved excellent effects in im-proving pregnancy rate. This article reviews the domestic and foreign methods of treating unexplained recurrent miscarriage in order to provide clinical reference. In the future,the combination of Chinese and Western medicine should become the main therapy to increase pregnancy rate.
1 Rahnama R,Rafiee M,Fouladi S,et al.Gene expression analysis of membrane progesterone receptors in women with recurrent spontaneous abortion:A case control study[J].BMC Res Notes,2019,12(1):790.
2 Kataoka K,Tomiya Y,Sakamoto A,et al.Altered autonomic nervous system activity in women with unexplained recurrent pregnancy loss[J].J Obstet Gynaecol Res,2015,41(6):912-918.
3陈建玲.380例淋巴细胞主动免疫疗法治疗不明原因的复发性流产疗效观察[J].生殖医学杂志，2015,24(6):457-460.
4马征兵，王艳秋，张爱英，等.淋巴细胞主动免疫疗法在不明原因复发性流产患者中的应用[J].中国性科学，2015,24(6):88-90.
5吕春红，王连珠.丙种球蛋白联合淋巴细胞主动免疫治疗复发性流产的疗效[J].实用临床医药杂志，2016,20(7):96-98.
6黄晖，姜小玲，吴洪波，等.宫腔灌注粒细胞集落刺激因子对薄型子宫内膜患者冻融胚胎移植周期中子宫内膜厚度的影响[J].广西医学，2015,37(10):1400-1402,1406.
7 Mekinian A,Cohen J,Alijotas-Reig J,et al.Unexplained recurrent miscarriage and recurrent implantation failure:Is there a place for immunomodulation?[J].Am J Reprod Immunol,2016,76(1):8-28.
8 Zafardoust S,Akhondi MM,Sadeghi MR,et al.Efficacy of intrauterine injection of granulocyte colony stimulating factor(G-CSF) on treatment of unexplained recurrent miscarriage:A pilot RCT study[J].J Reprod Infertil,2017,18(4):379-385.
9贾新转，魏兰，郭丽娜，等.醋酸泼尼松治疗URSA对临床结局及NK细胞表型的影响[J].山东大学学报（医学版），2016,54(5):62-65.
10欧华，郁琦.阿司匹林、泼尼松及爱乐维联合用药在治疗不明原因早期复发性自然流产中的效果观察[J].中华医学杂志，2017,97(41):3250-3254.
11吴娟，张冰璟.环孢素A治疗难治性免疫性复发性流产的临床效果分析[J].北方药学，2016,13(2):44-45.
12 Azizi R,Ahmadi M,Danaii S,et al.Cyclosporine A improves pregnancy outcomes in women with recurrent pregnancy loss and elevated Th1/Th2 ratio[J].J Cell Physiol,2019,234(10):19039-19047.
13高艳霞，杨波，孙前，等.原因不明习惯性流产患者肿瘤坏死因子-α和转化生长因子-β的表达及临床意义[J].临床误诊误治，2015,28(5):103-107.
14 Furukawa K,Maeshima E,Ichinose M.Case of successful pregnancy and childbirth in a rheumatoid arthritis patient treated with etanercept[J].Nihon Rinsho Meneki Gakkai Kaishi,2013,36(1):47-51.
15 Shaaban OM,Abbas AM,Zahran KM,et al.Low-Molecular-Weight heparin for the treatment of unexplained recurrent miscarriage with negative antiphospholipid antibodies:A randomized controlled trial[J].Clin Appl Thromb Hemost,2017,23(6):567-572.
16 Abou-Saif AH,Alkholy EA,Hammad RH,et al.The effect of low molecular weight heparin in recurrent pregnancy loss:Changes in radial uterine artery blood flow and peripheral blood NK cell fraction[J].Egypt J Immunol,2018,25(2):75-85.
17岳钊平，赵小玲，张娟，等.低分子肝素钠治疗复发性流产的临床疗效观察[J].华南国防医学杂志，2018,32(6):376-378.
18黄珊珊，罗奕巾.低分子肝素钙治疗高凝状态复发性流产的疗效观察[J].广东医学，2018,39(s1):227-228.
19 Maged AM,Abdelhafiz A,Mostafa WA,et al.The role of prophylactic use of low dose aspirin and calheparin in patients with unexplained recurrent abortion[J].Gynecol Endocrinol,2016,32(12):970-972.
20王慧娟，唐淑稳.肝素联合阿司匹林用于不明原因复发性流产患者效果观察[J].山东医药，2016,56(32):89-91.
21赵骏达，梁凌云，马俊旗.阿司匹林联合泼尼松对复发性流产孕妇妊娠结局及机体免疫平衡的影响[J].新疆医科大学学报，2019,42(9):1167-1170.
22杨倩.地屈孕酮辅助主动免疫疗法治疗复发性流产的疗效观察[J].药物流行病学杂志，2016,25(2):83-86.
23 Ismail AM,Abbas AM,Ali MK,et al.Peri-conceptional progesterone treatment in women with unexplained recurrent miscarriage:A randomized double-blind placebocontrolled trial[J].J Matern Fetal Neonatal Med,2018,31(3):388-394.
24张燕萍.滋肾育胎丸联合地屈孕酮治疗黄体功能不全所致复发性流产[J].中国计划生育学杂志，2019,27(8):1027-1030.
25李维宏，牟晓玲.黄体酮保胎治疗对不明原因复发性流产患者外周血辅助性T淋巴细胞17/调节性T淋巴细胞免疫失衡的影响研究[J].中国全科医学，2015,18(36):4444-4449.
26徐清华，韩宁.固肾安胎丸联合黄体酮胶囊治疗原因不明性复发性流产临床分析[J].中国计划生育学杂志，2018,26(6):455-459.
27 Fox C,Azores-Gococo D,Swart L,et al.Luteal phase HCG support for unexplained recurrent pregnancy lossa low hanging fruit?[J].Reprod Biomed Online,2017,34(3):319-324.
28唐志霞，江长君，洪名云，等.阿托西班联合人绒毛膜促性腺激素宫腔灌注对不孕症患者妊娠结局的影响[J].安徽医学，2017,39(5):529-532.
29高学娟，闫绍颖，段志芳.中西医结合治疗对原因不明复发性流产血清同型半胱氨酸（Hcy）、抗心磷脂抗体（ACA）水平的影响[J].中华中医药学刊，2018,36(8):2045-2048.
30许玉刚.中药加艾灸治疗脾肾阳虚型多囊卵巢综合征不孕128例疗效观察[J].世界中医药，2014,9(8):1079-1082.
31杨慧，崔海峰.补肾健脾法治疗不明原因复发性流产疗效研究[J].中国妇幼保健，2016,31(19):4021-4022.
32杨秀芳，侯丽，肖永峰，等.补肾益气养血方对原因不明性复发性流产血管生成相关因子的影响[J].现代中西医结合杂志，2016,25(17):1842-1844.
33陈晶晶，何耀娟，陈爱兰，等.中西医结合孕前孕后并治不明原因早期复发性流产疗效研究[J].陕西中医，2018,39(7):827-829.
34邱云，杨巧月，戴焕初，等.中医分期治疗多囊卵巢综合征诱发不孕症临床研究[J].中医学报，2016,31(5):711-714.
35冯晓玲，李娜，时思毛，等.补肾活血方对抗心磷脂抗体阳性复发性流产的临床研究[J].中医药信息，2015,32(2):34-36.
36杨学红.益气温经养血活血方对复发性流产妇女子宫内膜及卵巢血流动力学的影响[J].吉林中医药，2017,37(7):685-688.
37向英，邓阿黎，金晶，等.中药补肾活血方联合穴位贴敷治疗封闭抗体阴性复发性流产的疗效及对患者IL-10、TGF-β1指标的影响[J].世界中医药，2018,13(6):1424-1427.
38冯晓玲，李强，李嘉玮，等.补肾活血方对不明原因复发性流产患者血清中IL-13、IL-33的影响[J].广州中医药大学学报，2019,36(5):625-630.
39郭玉霞，马利国，李明娥，等.针灸对原因不明复发性流产患者外周血CD4+CD8+T细胞的影响[J].山西医药杂志，2015,44(7):760-762.
40袁晓兰，和秀魁，何田田，等.中医腹针疗法联合阿司匹林对复发性流产患者Th1/Th2型细胞因子的影响[J].广州医科大学学报，2017,45(5):9-11.
基本信息:
DOI：10.13210/j.cnki.jhmu.20210119.003
中图分类号:R714.21
引用信息:
[1]曲云青,冯晓玲,韩智宇.不明原因复发性流产中西医治疗的研究进展[J].海南医学院学报,2022,28(12):949-953+960.DOI:10.13210/j.cnki.jhmu.20210119.003.
基金信息:
国家自然科学基金资助项目（81973894）~~
2021-01-19
2021-01-19
2021-01-19