Distribution Of TCM Syndromes And Its Related Factors In Patients With Early Threatened Abortion In Lingnan Area

ObjectiveTo explore the distribution pattern of TCM syndromes of patients with early threatened abortion in Lingnan area and analyze its related factors,so as to provide clinical basis for further understanding the pathogenesis characteristics of patients with early threatened abortion in Lingnan area and quantification and objectification of syndrome differentiation.MethodsThe diagnosis and treatment information of threatened abortion patients who visited the gynecological ward and outpatient department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from March 2019 to September 2020 and prospectively from October 2020 to January 2021 were collected retrospectively.According to the admission and discharge standards,eligible cases were screened and a "threatened abortion patient database" was established.According to the attributes and characteristics of threatened abortion syndrome type,there were two groups:(1)deficiency syndrome group(deficiency of kidney,deficiency of spleen and kidney,deficiency of qi and blood),deficiency and deficiency group(deficiency of spleen and kidney combined with phlegm dampness,deficiency of spleen and kidney combined with liver depression,deficiency of kidney and liver depression,deficiency of kidney and blood stasis)and heat syndrome group(deficiency of kidney and blood heat).(2)Yin syndrome group(deficiency syndrome group + deficiency and excess mixed group)and Yang syndrome group(kidney deficiency and blood heat).The general information of the patients(age,days of menopause,height,weight,mode of pregnancy),personal history(smoking,drinking,noise environment,staying up late,sleep quality),pregnancy and birth history(number of pregnancy,birth,abortion and spontaneous abortion,mode of birth),history of common diseases in gynecology and internal medicine,TCM syndromes,etc.Auxiliary examinations(blood analysis,four items of coagulation,D-dimer,three items of thyroid function of pregnancy,and color ultrasound of uterine adnexa)were performed.The outcome of 12 weeks of pregnancy was collected through electronic medical records and telephone follow-up.On the one hand,the collected syndromes were counted for frequency distribution,and the main disease sites and syndrome elements were extracted according to the high-frequency syndromes.On the other hand,the relationship between different syndromes and related factors was compared according to the grouping of syndrome types.SPSS21.0 statistical analysis software was used to complete the statistical analysis to explore the distribution of TCM syndromes of threatened abortion and the relationship between them and related factors.Results1.The frequency of the top 20 syndromes from high to low in turn for breast tenderness,Gan Yan dry mouth,urine yellow,forgetfulness bilge painful,lumbar acid,exhausted god limb tiredly,nausea,vomiting,pee frequency and clear,hair loss,abdominal distension,nocturia,aversion to cold,and cold limbs,upset,insomnia,vaginal bleeding,less tastelessness,leucorrhea quantity,poor appetite,more spontaneous abortions(Tai Ting),greasy mouth,the lower abdomen stab.Study results of syndromes:80cases of kidney deficiency syndrome(29.2%)>deficiency of spleen and kidney combined with phlegm and dampness 60 cases(21.9%)> deficiency of kidney and blood fever 46cases(16.8%)> deficiency of spleen and kidney combined with liver stagnation 39 cases(14.2%)> deficiency of spleen and kidney combined with liver stagnation 30 cases(10.9%)> deficiency of kidney and liver stagnation 10 cases(3.6%)> deficiency of qi and blood 5 cases(1.8%)> deficiency of kidney and blood stasis 4 cases(1.4%).Syndrome type grouping 1: there were 124 cases(45.3%)in the deficiency syndrome group,104 cases(38.0%)in the deficiency syndrome mixed syndrome group,and 46 cases(16.8%)in the heat syndrome group.Group 2:228 cases(83.2%)in the negative syndrome group;There were 46 cases(16.8%)in the positive syndrome group.2.There were 222 cases(81.9%)of threatened abortion with irregular menstruation(or symptoms before and after menstruation).In the syndrome differentiation and classification of threatened abortion,most of the patients with light menstruation color belonged to false syndrome(80.6%),and most of the patients with dark menstruation color belonged to mixed syndrome of false and solid(66.7%).The patients with normal menstruation accompanied by breast pain,impatience and irritability were more likely to distinguish between deficiency and excess syndrome and blood fever syndrome(P < 0.05).The patients with blood clot,abdominal pain and stool formation were more likely to distinguish between deficiency and excess syndrome(P < 0.05).3.Deficiency syndrome,blood heat,inclusions in the presence of uterine fibroids and endometriosis(or)and(or)history of uterine adenomyosis,with and without polycystic ovary syndrome and(or)and(or)kaohsiung history of hyperprolactinemia,presence of pelvic inflammatory disease and(or)reproductive tract infection history,history of uterine surgery operation,have no noise environment,the high strength work,under the presence of chorionic blood There were significant differences in the mean values of Activated Partial Prothrombin Time(APTT),Fibrinogen(FBG),and area of subchorionic hematoma(P < 0.05).There were no significant differences in age,BMI,occupation and number of pregnancies(P > 0.05).In the patients with elevated Thyroid Peroxidase Antibody(TPO＿Ab),the mean value of TPO＿Ab in the Thyroid syndrome group was greater than that in the positive syndrome group(P < 0.05).However,there was no significant difference in the Thyroid Stimulating Hormone(TSH)and Free Thyroxine(FT4)between the two groups(P > 0.05).4.In terms of physique,the top four were 27 cases of Yang deficiency(36.5%)and 15 cases of qi stagnation(20.3%)and 11 cases of qi deficiency(14.9%)and 6 cases of phlegm-dampness(8.0%)of >.The syndrome types of threatened abortion in the patients with Yang deficiency and qi deficiency were mainly deficiency syndrome and deficiency and solid syndrome,Yin deficiency syndrome was mostly blood heat syndrome and deficiency syndrome,phlegm dampness and qi stagnation syndrome were mainly deficiency and solid syndrome,dampness and heat syndrome were mostly blood heat syndrome and deficiency and solid syndrome,and blood stasis syndrome was mainly deficiency and deficiency and solid syndrome.5.There were 252 cases with 12-week pregnancy outcome,among which 193 cases(76.6%)sustained pregnancy and 59 cases(23.4%)failed.In comparison of syndromes,persistent lumbar pain and weakness in the early trimester were the risk factors for the outcome of 12 weeks of pregnancy,which were correlated with the degree.In the comparison of syndrome types,there was no significant difference in the distribution of pregnancy outcomes among the deficiency syndrome group,deficiency and excess syndrome group and blood heat syndrome group,but the pregnancy failure rate in the blood heat group was relatively higher,and the patients with the history of staying up late and smoking in this group were higher than the other two groups(P < 0.05).The pregnancy failure rate of patients with uterine fibroids and/or endometriosis and/or adenomyosis and/or pelvic inflammatory disease was higher than that of patients without such history in the mixed syndrome group(P < 0.05).Conclusion1.The disease location syndrome of early threatened abortion patients was mainly kidney,followed by spleen,stomach,liver and heart;The main syndromes were qi deficiency and Yang deficiency,followed by phlegm dampness,blood heat,Yin deficiency,qi stagnation and blood stasis.The main syndromes were kidney deficiency,spleen-kidney deficiency and its combination,kidney deficiency and blood heat syndrome.The constitution of TCM is mainly composed of Yang deficiency,qi stagnation and qi deficiency.2.The TCM syndromes of threatened abortion patients are related to TCM constitution type,menstrual situation,previous gynecological history,and personal history.Persistent low back pain or fatigue was a risk factor for 12 week pregnancy outcome and correlated with degree.Blood heat syndrome is associated with a history of staying up late and smoking,and the pregnancy failure rate is higher.In the case of chronic chronic disease with deficiency and solid syndrome,the rate of pregnancy failure was significantly high.3.Patients with coagulation and fibrinolysis imbalance and subchorionic bleeding in early pregnancy are mostly patients with mixed syndrome of deficiency and excess;In patients with threatened abortion with elevated TPO＿Ab and identified as negative witnesses,more attention should be paid to thyroid function in the later stage.