补肾活血方对复发性流产伴子宫动脉血流高阻患者VEGF、sFlt-1表达的影响

叶 骞 王欢欢 董盼攀 袁慧慧 陈悠然 叶平

[摘要] 目的 探討补肾活血方对复发性流产伴子宫动脉血流高阻患者的血管内皮生长因子（VEGF）、可溶性血管内皮生长因子受体1（sFlt-1）及子宫动脉血流阻力的影响。 方法 回顾性分析2017年1月至2019年12月在我院生殖免疫科就诊的复发性流产伴子宫动脉血流高阻的75例患者病例资料，依据治疗经过分为空白对照组11例，其余治疗组分别在排卵后予低分子肝素（西药组21例）、补肾活血方（中药组19例）及低分子肝素联合补肾活血方（中西药组24例），比较各组在妊娠5周时子宫动脉血流阻力及血清VEGF、sFlt-1的表达情况。 结果 各治疗组在妊娠5周复查的子宫动脉血流阻力指数较治疗前均有显著降低，差异有统计学意义（P<0.05），但是各组间两两比较，差异无统计学意义（P>0.05）;四组患者在妊娠5周血清VEGF的表达水平比较，差异无统计学意义（P>0.05）;各治疗组在妊娠5周的sFlt-1表达水平均明显低于对照组，差异有统计学意义（P<0.05）。 结论 补肾活血方可降低复发性流产患者的子宫动脉血流阻力指数，其作用机制可能与下调血清sFlt-1的表达有关。

[关键词] 补肾活血方;复发性流产;血管内皮生长因子;可溶性血管内皮生长因子受体1;子宫动脉

[中图分类号] R714.2          [文献标识码] B          [文章编号] 1673-9701（2021）13-0135-04

Effect of Bushen Huoxue Recipe on expression of VEGF and sFlt-1 in patients with recurrent abortion accompanied by high uterine artery blood flow resistance

YE Qian1   WANG Huanhuan1   DONG Panpan1   YUAN Huihui2   CHEN Youran2   YE Ping1

1.Department of Reproductive Immunology， Tongde Hospital of Zhejiang Province， Hangzhou   310012， China; 2.Zhejiang Chinese Medical University， Hangzhou   310053， China

[Abstract] Objective To explore the effect of Bushen Huoxue Recipe on vascular endothelial growth factor （VEGF）， soluble vascular endothelial growth factor receptor 1 （sFlt-1） and uterine artery blood flow resistance in patients with recurrent abortion accompanied by high uterine artery blood flow resistance. Methods The data of 75 patients with recurrent abortion and high uterine artery blood flow resistance who visited the reproductive immunology department of our hospital from January 2017 to December 2019 were retrospectively analyzed. According to the treatment process， there were divided into the blank control group（11 cases）， low molecular weight heparin（21 cases in the western medicine group）， Bushen Huoxue Recipe（19 cases in the traditional Chinese medicine group） and bushen huoxue recipe combined with low molecular weight heparin（24 cases in the Chinese herbs and Western medicine group）. The uterine artery blood flow resistance and the expression of VEGF and sFlt-1 in serum of each group were compared at the 5th week of pregnancy. The other treatment groups were given. Results The uterine artery blood flow resistance index reexamined at the 5th week of pregnancy was significantly lower in each treatment group than that before treatment，and the difference was statistically significant（P<0.05）， but there was no significant difference between the two groups（P>0.05）. There was no statistical significance in the expression level of serum VEGF among the four groups at the 5th week of pregnancy（P>0.05）. The expression level of sFlt-1 was significantly lower in each treatment group at the 5th week of pregnancy than that in the control group， and the difference was statistically significant（P<0.05）. Conclusion Bushen Huoxue Recipe can reduce uterine artery blood flow resistance index in patients with recurrent abortion， and its mechanism of action may be related to the down-regulation of serum sFlt-1 expression.

[Key words] Bushen Huoxue Recipe; Recurrent abortion; Vascular endothelial growth factor; Soluble vascular endothelial growth factor receptor 1; Uterine artery

复发性流产（Recurrent spontaneous abortion，RSA）是指与同一性伴侣连续发生2次及以上妊娠物或胎儿丢失[1]，发生率为5%左右[2]，且随着流产次数的增加再发流产的风险也明显增加[3]。复发性流产病因复杂，其发病机制至今仍未完全明確，有部分研究表明，妊娠过程中胎盘绒毛组织血管形成障碍和滋养层细胞入侵子宫内膜障碍可能是导致复发性流产发生的直接原因[4-5]，而血管内皮生长因子及其相关受体又是血管形成的重要调节因子，可能参与其中。子宫……