目的:探究自拟清肝退黄汤预防母婴血型不合的疗效。方法:选择100例血型为O型Rh(D)阳性,丈夫为非O型Rh(D)阳性的孕妇,随机分为对照组和研究组,对照组采用维生素C + 维生素E治疗,研究组采用自拟清肝退黄汤治疗,直至分娩,观察患者的抗体效价、中医症候在治疗前后的变化及妊娠合并症、新生儿病理性黄疸的发生率等情况。结果:1) 对照组患者治愈5例,有效24例,无效21例,总有效率58%;研究组患者治愈8例,有效36例,无效6例,总有效率88%,明显高于对照组,有统计学差异(P < 0.05)。2) 治疗后研究组患者中医症候积分明显低于对照组,有统计学差异(P < 0.05)。3) 治疗后研究组患者抗体效价明显低于对照组,有统计学差异(P < 0.05)。4) 对照组5名患者发生妊娠时限异常,3名患者出现胎儿宫内发育迟缓,2名患者出现胎儿宫内窘迫,妊娠合并症总发生率20%;研究组1名患者发生妊娠时限异常,无胎儿宫内发育迟缓或宫内窘迫,妊娠合并症总发生率2%,显著低于对照组,有统计学差异(P < 0.05)。5) 治疗结束,对照组最终48名新生儿出生,其中病理性黄疸有15例,占31.25%;研究组最终49名新生儿出生,其中病理性黄疸有4例,占8.16%,显著低于对照组,有统计学差异(P < 0.05)。结论:自拟清肝退黄汤可有效改善母婴血型不合孕妇的中医症候,降低抗体效价,预防妊娠合并症,明显降低了新生儿病理性黄疸的发生率,其疗效明显优于西药组。 Objective: To explore the effect of Qinggan Tuihuang decoction on preventing maternal-fetal blood type incompatibility. Methods: A total of 100 pregnant women with positive blood type O Rh(D) and their husbands non-O Rh(D) positive were randomly divided into control group and study group. The control group was treated with vitamin C + vitamin E, while the study group was treated with self-designed Qinggan Tuihuang decoction until delivery. The changes of antibody titer and TCM symptoms were observed before and after treatment, and the incidence of pregnancy complications with neonatal pathological jaundice were counted after treatment. Results: 1) In the control group, 5 cases were cured, 24 cases were effective, 21 cases were ineffective, and the total effective rate was 58%; In the study group, 8 cases were cured, 36 cases were effective, and 6 cases were ineffective, with a total effective rate of 88%, which was significantly higher than that of the control group with statistical difference (P < 0.05). 2) After treatment, the TCM symptom scores of the study group were significantly lower than those in the control group, with statistical difference (P < 0.05). 3) After treatment, the antibody titer in the study group was significantly lower than that in the control group, with statistical difference (P < 0.05). 4) In the control group, 5 patients had abnormal pregnancy duration, 3 patients had intrauterine growth retardation, 2 patients had intrauterine fetal distress, and the total incidence of pregnancy complications was 20%. In the study group, one patient had abnormal pregnancy duration, no intrauterine growth retardation or intrauterine distress, and the total incidence of pregnancy complications was 2%, which was significantly lower than that in the control group with statistical difference (P < 0.05). 5) At the end of the treatment, 48 neonates in the control group were finally born, of which 15 cases were pathological jaundice, accounting for 31.25%; 49 neonates in the study group were finally born, of which 4 cases were pathological jaundice, accounting for 8.16%, which was significantly lower than that of the control group, with statistical difference (P < 0.05). Conclusion: The self-designed Qinggan Tui-huang Decoction can effectively improve the TCM symptoms of pregnant women with maternal-fetal blood type incompatibility, reduce the antibody titer, prevent pregnancy complications, and significantly reduce the incidence of neonatal pathological jaundice, and its curative effect is significantly better than the western medicine group.
目的:探究自拟清肝退黄汤预防母婴血型不合的疗效。方法:选择100例血型为O型Rh(D)阳性,丈夫为非O型Rh(D)阳性的孕妇,随机分为对照组和研究组,对照组采用维生素C + 维生素E治疗,研究组采用自拟清肝退黄汤治疗,直至分娩,观察患者的抗体效价、中医症候在治疗前后的变化及妊娠合并症、新生儿病理性黄疸的发生率等情况。结果:1) 对照组患者治愈5例,有效24例,无效21例,总有效率58%;研究组患者治愈8例,有效36例,无效6例,总有效率88%,明显高于对照组,有统计学差异(P < 0.05)。2) 治疗后研究组患者中医症候积分明显低于对照组,有统计学差异(P < 0.05)。3) 治疗后研究组患者抗体效价明显低于对照组,有统计学差异(P < 0.05)。4) 对照组5名患者发生妊娠时限异常,3名患者出现胎儿宫内发育迟缓,2名患者出现胎儿宫内窘迫,妊娠合并症总发生率20%;研究组1名患者发生妊娠时限异常,无胎儿宫内发育迟缓或宫内窘迫,妊娠合并症总发生率2%,显著低于对照组,有统计学差异(P < 0.05)。5) 治疗结束,对照组最终48名新生儿出生,其中病理性黄疸有15例,占31.25%;研究组最终49名新生儿出生,其中病理性黄疸有4例,占8.16%,显著低于对照组,有统计学差异(P < 0.05)。结论:自拟清肝退黄汤可有效改善母婴血型不合孕妇的中医症候,降低抗体效价,预防妊娠合并症,明显降低了新生儿病理性黄疸的发生率,其疗效明显优于西药组。
母婴血型不合,清肝退黄,抗体效价,新生儿黄疸,胎黄病
Yu Feng, Tingting Ju
Yiwu Maternity and Children Hospital, Yiwu Zhejiang
Received: Aug. 27th, 2022; accepted: Sep. 19th, 2022; published: Sep. 27th, 2022
Objective: To explore the effect of Qinggan Tuihuang decoction on preventing maternal-fetal blood type incompatibility. Methods: A total of 100 pregnant women with positive blood type O Rh(D) and their husbands non-O Rh(D) positive were randomly divided into control group and study group. The control group was treated with vitamin C + vitamin E, while the study group was treated with self-designed Qinggan Tuihuang decoction until delivery. The changes of antibody titer and TCM symptoms were observed before and after treatment, and the incidence of pregnancy complications with neonatal pathological jaundice were counted after treatment. Results: 1) In the control group, 5 cases were cured, 24 cases were effective, 21 cases were ineffective, and the total effective rate was 58%; In the study group, 8 cases were cured, 36 cases were effective, and 6 cases were ineffective, with a total effective rate of 88%, which was significantly higher than that of the control group with statistical difference (P < 0.05). 2) After treatment, the TCM symptom scores of the study group were significantly lower than those in the control group, with statistical difference (P < 0.05). 3) After treatment, the antibody titer in the study group was significantly lower than that in the control group, with statistical difference (P < 0.05). 4) In the control group, 5 patients had abnormal pregnancy duration, 3 patients had intrauterine growth retardation, 2 patients had intrauterine fetal distress, and the total incidence of pregnancy complications was 20%. In the study group, one patient had abnormal pregnancy duration, no intrauterine growth retardation or intrauterine distress, and the total incidence of pregnancy complications was 2%, which was significantly lower than that in the control group with statistical difference (P < 0.05). 5) At the end of the treatment, 48 neonates in the control group were finally born, of which 15 cases were pathological jaundice, accounting for 31.25%; 49 neonates in the study group were finally born, of which 4 cases were pathological jaundice, accounting for 8.16%, which was significantly lower than that of the control group, with statistical difference (P < 0.05). Conclusion: The self-designed Qinggan Tuihuang Decoction can effectively improve the TCM symptoms of pregnant women with maternal-fetal blood type incompatibility, reduce the antibody titer, prevent pregnancy complications, and significantly reduce the incidence of neonatal pathological jaundice, and its curative effect is significantly better than the western medicine group.
Keywords:Maternal-Fetal Blood Type Incompatibility, Qinggan Tuihuang, Antibody Titer, Neonatal Jaundice, Taihuang Disease
Copyright © 2022 by author(s) and Hans Publishers Inc.
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母婴ABO血型不合是指O型血的孕妇与非O型血的配偶婚育,母体与胎儿之间因血型不同而产生的同种免疫性疾病,孕妇体内的红细胞血型免疫抗体(抗A、抗B)因其分子量小,极易经胎盘途径与胎儿体内的红细胞结合,引起胎儿体内红细胞凝集破坏而产生溶血症。ABO血型抗原在自然界中分布广泛,母体可因多种因素而致敏,故ABO血型不合在第一次妊娠时即可发生,据统计孕期筛查发现母婴ABO血型不合的孕妇约占我国妊娠总数的27.7% [
本研究选取2020年至2022年在我院就诊的孕妇100例,孕妇血型均为O型Rh(D)阳性,丈夫为A、B或AB型Rh(D)阳性作为研究对象。患者年龄为21~40岁之间,平均年龄25.6岁,初诊孕周介于12~24周之间。(本研究方案经医院伦理委员会批准,受试者均签署知情同意书。)
参照《中医妇科学》诊断标准血型检查及抗体效价测定,夫妇血型不合,妻子血型为O型Rh(D)阳性,丈夫血型为非O型Rh(D)阳性,抗体效价 ≥ 1:64。
患者无法耐受药物治疗或其他原因,中途要求退出本研究。
将100例患者随机分为研究组、对照组,两组患者的年龄、孕周、孕产次等一般资料相比较,差异无统计学意义(P > 0.05),具有可比性。
观察两组患者治疗前后的中医症候、抗体效价的变化情况,统计两组患者妊娠合并症及新生儿病理性黄疸的发生率。
研究组方案:予自拟清肝退黄汤加减。药物组成:茵陈20 g、炒栀子10 g、紫草10 g、蛇舌草15 g、青蒿10 g、胡黄连6 g、蒲公英15 g、大青叶10 g、黄芩10 g、黄柏10 g、旱莲草10 g、生地黄10 g、钩藤10 g、郁金10 g、柴胡10 g、白芍10 g、玉米须15 g、金银花10 g、茯苓10 g。每日1剂,水煎2次取汁400 mL,分早、晚口服。以本方为主方,根据患者气血、阴阳辨证辨病相结合,随证加入健脾固肾、芳香化湿、健脾渗湿、清热解毒或固胎安胎药物。
对照组方案:予西药治疗。维生素C注射液(山西晋新双鹤药业有限责任公司),国药准字(H14022704) 1 g加入10%葡萄糖注射液250 mL,每日1次静脉滴注、维生素E胶丸(天津市中央药业有限公司),国药准字(H12020262) 100 mg,每日1次口服。两组患者均4周为1个疗程。治疗时间为从确诊至分娩,嘱其慎起居,调情志,节饮食。
治愈:临床症状消失,且抗体效价 < 1:64,新生儿未见异常。有效:临床症状明显减轻,抗体效价呈对半或对半以上下降或维持不变,产前B超提示胎儿发育正常,未发生早产、死胎,新生儿存活,分娩后新生儿正常或轻度黄疸,于3天内开始退黄,10天左右黄疸完全消退。无效:临床症状未见改善,抗体效价持续升高,发生流产、死胎、早产及新生儿溶血性黄疸者。
使用SPSS 25.0软件进行统计分析。计数资料以率(%)表示,采用χ2检验,计量资料以( x ¯ ± s )表示,以P < 0.05为有统计学差异。
1) 临床总疗效:治疗后,对照组治愈5例,有效24例,无效21例,总有效率58%;研究组治愈8例,有效36例,无效6例,总有效率88%,明显高于对照组,有统计学差异(P < 0.05),见表1。
n | 治愈 | 有效 | 无效 | 有效率 | |
---|---|---|---|---|---|
研究组 | 50 | 8 | 36 | 6 | 88% |
对照组 | 50 | 5 | 24 | 21 | 58% |
表1. 两组临床总疗效比较
2) 中医症候积分:治疗前,2组中医症候总积分无统计学差异(P > 0.05);治疗后两组中医症候积分均较治疗前降低,有统计学差异(P < 0.05),且研究组明显低于对照组,有统计学差异(P < 0.05),自拟清肝退黄汤对于改善患者中医症候有显著疗效,见表2。
中医症候积分 | n | 治疗前 | 治疗后 |
---|---|---|---|
研究组 | 50 | 15.60 ± 1.82 | 6.96 ± 1.64 |
对照组 | 50 | 15.06 ± 1.53 | 10.96 ± 1.74 |
表2. 中医症候积分比较
3) 抗体效价:治疗前,2组抗体效价无统计学差异(P > 0.05);治疗后,两组抗体效价均较治疗前降低,有统计学差异(P < 0.05),且研究组的抗体效价明显低于对照组,有统计学差异(P < 0.05),自拟清肝退黄汤在降低孕期抗体效价方面效果确切,见表3。
抗体效价 | n | 治疗前 | 治疗后 |
---|---|---|---|
研究组 | 50 | 655.36 ± 306.68 | 381.44 ± 289.69 |
对照组 | 50 | 693.76 ± 326.17 | 546.56 ± 322.27 |
表3. 抗体效价比较
4) 两组孕妇妊娠期合并症发生情况:研究组孕妇怀孕期间发生妊娠时限异常1例,胎儿宫内发育迟缓0例,胎儿宫内窘迫 0例,总发生率2%;对照组孕妇怀孕期间发生妊娠时限异常5例,胎儿宫内发育迟缓3例,胎儿宫内窘迫2例,总发生率20%,显著高于研究组,有统计学差异(P < 0.05),自拟清肝退黄汤可以有效预防血型不合孕妇妊娠合并症的发生,见表4。
n | 无 | 妊娠时限异常 | 胎儿宫内 发育迟缓 | 胎儿宫内窘迫 | 妊娠期合并 症总发生率 | |
---|---|---|---|---|---|---|
研究组 | 50 | 49 | 1 | 0 | 0 | 2% |
对照组 | 50 | 40 | 5 | 3 | 2 | 20% |
表4. 妊娠期合并症发生情况比较
5) 新生儿病理性黄疸发生情况:研究组治疗期间1名孕妇流产,最终49名新生儿出生,其中发生病理性黄疸有4例,占8.16%;对照组中途2名孕妇流产,最终48名新生儿出生,其中发生病理性黄疸有15例,占31.25%,显著高于研究组,有统计学差异(P < 0.05),自拟清肝退黄汤可以有效降低新生儿病理性黄疸的发生率,见表5。
n | 无 | 有 | 新生儿病理性黄疸发生率 | |
---|---|---|---|---|
研究组 | 49 | 45 | 4 | 8.16% |
对照组 | 48 | 33 | 15 | 31.25% |
表5. 新生儿病理性黄疸发生情况比较
母婴ABO血型不合是产科疑难疾病之一,可导致胎儿溶血、贫血,孕妇流产、早产甚至死胎等,亦是新生儿溶血病的主要根源,约占所有血型不合溶血的90%以上 [
中医学对母婴ABO血型不合早有论述,隋代巢元方《诸病源候论》中指出“小儿在胎,其母脏气有热,熏蒸于胎,致生下小儿遍体皆黄,为之胎疸”,明确提出了胎疸之病名。宋代钱乙《小儿药证直诀》中提及:“又有自生而生黄者,胎疸也”,清代陈飞霞《幼幼集成》亦载“胎黄,此胎中受湿热也”。《证治准绳·幼科》认为:“此胎黄之侯,皆因乳母受湿热而传于胎也。”指出发黄的原因与母体体质、胎热以及湿热等因素有关。《幼科铁镜》云:“胎黄,由妊母感受湿邪传于胞胎,故儿新生面目通身皆黄如金色,壮热便秘,尿赤。”古代医家已明确指出,胎黄即胎禀所致之黄疸。《医宗金鉴》载“胎黄者,遍体面目皆黄,其色如金,乃孕妇湿热太盛,小儿在胎受母体热毒,故生则有是证也,法当渗湿清热……”。
笔者认为本病的发生多由母体孕育之时,湿热熏蒸于胞宫所致,病因为湿邪阻滞,淤积发黄。一方面胎儿感受母体湿热之邪未能输化,郁蒸肝胆;另一方面,湿邪粘滞,郁阻血脉,气血运行不畅,以致肝失舒泄,胆汁外溢而蕴生黄疸,故有“母有湿热,热传胞胎,化为胎毒,瘀结在血而生后即发黄疸”。故本病关键在于母体湿热体质,加之平素嗜食肥甘厚腻,酿湿生热,或脾胃运化失司,湿邪内生,平素情志不畅,肝郁化火,中焦湿热蕴结,胎儿受湿热熏蒸,肝胆为病位所在,故临床多表现为面黄少华、两胁胀痛、烦躁易怒、腹胀厌食、口苦泛恶、大便秘结、小便黄等,舌红苔黄腻,脉滑数为其主要症候,治宜清肝利湿退黄。茵陈蒿汤为清肝利湿退黄的经典方剂,出自《伤寒论》,《伤寒论·辨阳明病脉证并治》曰:“伤寒七八日,身黄如橘子色,小便不利,腹微满者,茵陈蒿汤主之。”笔者自拟的清肝退黄汤在茵陈蒿汤的基础上化裁而成,具体药物组成:茵陈20 g、栀子10 g、紫草10 g、蛇舌草15 g、青蒿10 g、胡黄连6 g、蒲公英15 g、大青叶10 g、黄芩10 g、黄柏10 g、旱莲草10 g、生地黄10 g、钩藤10 g、郁金10 g、柴胡10 g、白芍10 g、玉米须15 g、金银花10 g、茯苓10 g。方中茵陈、青蒿、栀子为君药,清热凉血,清肝利胆退黄;生地黄、紫草、胡黄连、黄芩、黄柏、郁金为臣药,清热滋阴,利湿退黄;蛇舌草、蒲公英、大青叶、旱莲草、钩藤、白芍、玉米须、金银花、茯苓为佐药,清肝化湿,利胆退黄;柴胡引药入肝经,为使药,全方共奏清肝化湿退黄之功。脾主运化、肾主水,脾肾为水液运化的重要脏腑,湿邪的祛除离不开健脾益肾之法;同时脾为气血生化之源,主蕴养胞胎,肾主生殖,胞脉系于肾,主固胞胎,本着“治病与安胎并举”的原则,根据患者气血阴阳的不同,随证加入健脾益肾、固胎安胎之品。
本研究结果显示,与对照组维生素治疗相比,研究组清肝退黄汤的临床有效率更高、中医症候改善更明显、抗体效价降低更明显,妊娠并发症包括妊娠时限异常、胎儿宫内发育迟缓及胎儿宫内窘迫的发生率更低,且新生儿病理性黄疸的发生率更低,这表明清肝退黄汤可有效调节母婴血型不合孕妇的免疫功能,抑制抗体升高、减少红细胞破坏、降低胆红素水平、促进胆红素排泄,从而降低流产、早产或死胎等不良妊娠合并症的发生并预防新生儿病理性黄疸的发生。现代药理学研究显示,茵陈、黄芩中含量较多的A、B血型物质,这种物质是一种半抗原,可中和部分抗体,直接降低抗体浓度 [
综上所述,笔者自拟清肝退黄汤预防母婴血型不合的疗效确切,可有效预防母婴血型不合孕妇不良妊娠结局的发生,降低母体血型抗体效价,改善母体中医症候,降低新生儿病理性黄疸发生率,减少出生缺陷,促进母婴健康,值得临床推广应用。
义科2020-3-143;金卫[
冯 玉,鞠婷婷. 自拟清肝退黄汤预防母婴血型不合的疗效的临床研究Clinical Study on the Effect of Qinggan Tuihuang Decoction on Preventing Maternal-Fetal Blood Type Incompatibility[J]. 中医学, 2022, 11(05): 993-999. https://doi.org/10.12677/TCM.2022.115142