复发性流产合并遗传性易栓症的中西医研究与治疗进展

doi:10.12280/gjfckx.20251278

摘要/Abstract

摘要：

复发性流产合并遗传性易栓症是导致不良妊娠结局的重要病因。遗传性易栓症主要涉及抗凝蛋白缺陷（蛋白质C、蛋白质S、抗凝血酶Ⅲ）、凝血因子Ⅴ Leiden（FⅤL）突变、凝血酶原G20210A突变（PGM）、亚甲基四氢叶酸还原酶（methylenetetrahydrofolate reductase，MTHFR）基因多态性及纤溶酶原激活物抑制物-1（plasminogen activator inhibitor-1，PAI-1）5G/4G基因突变等。西医治疗以低分子肝素（low molecular weight heparin，LMWH）抗凝为主，通过改善高凝状态、促进胎盘血流灌注以降低流产风险，但目前缺乏高质量循证医学证据支持其疗效，临床应用仍存在争议。中医从“肾虚血瘀”病机出发，以“补肾活血”为根本治则，在整体辨证论治下寻求病因治疗，以经典方剂寿胎丸补肾固冲，配伍小剂量丹参、当归等活血化瘀药物治疗，临床实践颇有疗效。近年中西医结合治疗显示出良好的协同效应，在提高妊娠成功率的同时减少西药用量及不良反应，为复发性流产合并遗传性易栓症的治疗提供了新的思路和方法。

关键词: 流产，习惯性, 遗传性易栓症, 多态现象，遗传, 肝素，低分子量, 肾虚血瘀, 补肾活血

Abstract:

Recurrent spontaneous abortion (RSA) combined with hereditary thrombophilia is a significant cause of adverse pregnancy outcomes. Hereditary thrombophilia mainly involves deficiencies of anticoagulant proteins (protein C, protein S, antithrombin Ⅲ), factor Ⅴ Leiden (FⅤL) mutation, prothrombin G20210A gene mutation (PGM), methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms, and plasminogen activator inhibitor-1 (PAI-1) 5G/4G gene mutations. Western medical treatment primarily employs low molecular weight heparin (LMWH) anticoagulation to improve hypercoagulability and promote placental blood perfusion, thereby reducing abortion risk. However, there is currently a lack of high-quality evidence-based medical data supporting its efficacy, and its clinical application remains controversial. Traditional Chinese Medicine (TCM) follows the pathogenesis of "kidney deficiency and blood stagnation", adopting the therapeutic principle of "tonifying kidney and activating blood circulation". Under holistic syndrome differentiation, TCM seeks etiological treatment, using classic formulas such as Shoutai Pill to tonify kidney and stabilize the Chong Mai, combined with low-dose promoting blood circulation and removing blood stasis drugs like Salvia miltiorrhiza and Angelica sinensis. Clinical practice has demonstrated considerable efficacy. In recent years, integrated Chinese-Western medicine therapy has shown favorable synergistic effects, improving pregnancy success rate while reducing the dosage and adverse effects of Western medications, thereby providing novel therapeutic strategies for RSA complicated with hereditary thrombophilia.

Key words: Abortion, habitual, Hereditary thrombophilia, Polymorphism, genetic, Heparin, low-molecular-weight, Kidney deficiency and blood stagnation, Tonifying kidney and activating blood circulation

王成霞, 赵佳润, 郑舒畅, 王一迪, 何军琴. 复发性流产合并遗传性易栓症的中西医研究与治疗进展[J]. 国际妇产科学杂志, 2026, 53(2): 159-164.

WANG Cheng-xia, ZHAO Jia-run, ZHENG Shu-chang, WANG Yi-di, HE Jun-qin. Research and Therapeutic Advances in Recurrent Spontaneous Abortion Complicated with Hereditary Thrombophilia[J]. Journal of International Obstetrics and Gynecology, 2026, 53(2): 159-164.

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