| ObjectiveRecurrent Spontaneous Abortion(RSA)is a common pregnancy complication in obstetrics and gynecology,characterized by recurrent pregnancy failure,with a morbidity of 1%-5%.It usually occurs in early pregnancy,of which 80%RSA occurs within 12 weeks[1].The etiology of RSA is very complex,involving chromosome or genetic abnormalities,anatomical abnormalities of reproductive organs,infection,immune dysfunction,endocrine abnormalities,blood hypercoagulability and many other aspects.In addition,about 25%of RSA patients have no clear cause,which is called Unexplained Recurrent Spontaneous Abortion(URSA)[2].At present,modern medical treatment mainly adopts surgical therapy,anti-infection therapy,antithrombotic therapy,immunosuppressant therapy,endocrine therapy and Assisted Reproductive Technology.Although there are many treatment options,quite a few patients still fail to achieve good pregnancy outcome.The occurrence of repeated spontaneous abortion brings great psychological burden to patients,seriously reduces the quality of life of patients,destroys the harmony of patients’ families,and even leads to the breakup of many families.Therefore,it is extremely necessary to take effective and timely preventive measures to avoid the recurrence of abortion.With the transformation of the modern medical model into a bio-psycho-social model,psychological factors have been placed in a higher position,and people have a deeper understanding of the relationship between mental health and disease.Especially for URSA,many studies have confirmed that psychological factors are related to URSA adverse pregnancy outcome,and psychological intervention is helpful to improve pregnancy outcome[3,4].Constitution theory and Five-pattern Personality theory are important components of TCM psychology,and they are the embodiment of TCM prevention and treatment of diseases from the angle of "body and spirit integration".Studies have shown that people with certain physical or personality types have an increased susceptibility to certain diseases.Therefore,it is of great significance to study the distribution characteristics of TCM constitution and five-state personality of patients with Early Recurrent Miscarriage and their correlation with syndrome types for the prevention and treatment of Early Recurrent Miscarriage.TCM Constitution Classification and Evaluation Form and Five-state Personality Test Form are widely recognized by the TCM community.They can better reflect TCM constitution and fivepattern personality characteristics of different individuals and groups,both of them have high reliability and validity,and they have been widely used in clinical research.By investigating the general information of RSA patients,TCM syndrome types,TCM nine constitution types and Five-pattern Personality,this study explored the syndrome types,TCM constitution and Five-pattern Personality distribution characteristics of RSA patients,and explored the relationship among TCM constitution,Five-pattern Personality and syndrome types of RSA patients by using statistical methods and combined with clinical practice.In order to provide theoretical basis and clinical guidance for the prevention and treatment of RSA from the perspective of TCM psychology,and help more RSA patients to obtain a good pregnancy outcome.MethodThe questionnaire survey method was used in this study.A total of 150 patients with RSA who visited the gynecological clinic of Guang ’anmen Hospital,China Academy of Chinese Medical Sciences from June 2021 to January 2023 were included.The patients were made to fill out the General Information Questionnaire,TCM Constitution Classification and Judgment Form and the Five pattern personality Test Form independently in a quiet and undisturbed environment based on voluntary principle.The TCM syndrome types of RSA patients were judged by two TCM physicians with the title of associate senior or above according to the contents of TCM Syndrome Questionnaire combined with clinical practice.Before the survey,investigators were uniformly trained on the medical tRSAs involved in the scale and the matters needing attention to fill in the questionnaire,and on-site guidance was given to the questions that the participants did not understand,and the questionnaire was withdrawn on the spot after the completion of the questionnaire.EpiData3.1 software was used to input the original data,the data were checked by the method of two-person input,the original database was established,and SPSS26.0 software was imported for statistical analysis.Counting data were displayed by frequency statistics and described in the form of graphs and words.Measurement data were expressed as mean±standard deviation(x±s).The differences of measurement data were compared by t test,variance analysis and non-parametric test.Counting data were compared using chi-square tests.Correlation analysis was performed by Pearson and Spearman correlation analysis.P<0.05 meant the difference was statistically significant.Result1 General information:A total of 145 RSA patients meeting the criteria were included,mainly distributed in the age range of 27-40 years,including 69 patients aged 34-40 years(47.6%),50 patients aged 27-33 years(34.5%),25 patients aged 41-45 years(17.2%),and 1 patient aged 20-26 years(0.7%).79 people(54.5%)had normal BMI,32 people(22.1%)were overweight,17 people(11.7%)were obese and 17 people(11.7%)were thin.RSA patients generally had higher education,mainly with bachelor’s degree(80 cases,55.2%)and master’s degree(53 cases,36.6%).Most patients engaged in mental work(131 cases,90.3%);The economic conditions of patients’ families were generally good,and 80.0%of patients’ families had an annual income of more than 100,000 yuan.RSA is dominated by missed abortions,most of which are intrauterine pregnancy;The number of RSA abortions was distributed in 2-5 times,mainly with 2 abortions(107 cases,73.8%),most of which occurred at 8-10 weeks of gestation(48.2%).After aborting,most of the patients chose to clear the palace operation(95.5%).About half of the patients with fetal stop related etiology were complicated with fetal villus chromosome abnormality(55.2%).There were 2 cases of chromosome abnormality in RSA couples,1 case was heterotopic Roche of female non-homologous chromosome,and 1 case was chromosomal polymorphism Yqh+of male chromosome.There were 81 patients with anatomical abnormalities of reproductive organs,and 6 patients were congenital anatomical abnormalities of reproductive organs,including arcuate uterus(2 cases,33.3%),mediastinal uterus(1 case,16.7%),single horn uterus(1 case,16.7%),saddle-shaped uterus(1 case,16.7%)and double uterus(1 case,16.7%).Uterine fibroids(36.3%)were the most common anatomical abnormalities of acquired reproductive organs,followed by uterine adhesions(34.3%),endometrial polyps(12.7%),adenomyopathy(8.8%),endometritis(2.9%),endometriosis(1.9%),chronic pelvic inflammatory disease(1.9%)and cervical insufficiency(0.9%).There were 36 patients with endocrine abnormalities,including hypothyroidism(60%),Hashimoto’s thyroiditis(12.5%),hyperandrogenemia(10.0%),hyperprolactinemia(7.5%),insulin resistance syndrome(5%),luteal insufficiency(2.5%),and hyperthyroidism(2.5%).52 patients were diagnosed with thromboembolism,accounting for 38.8%;There were 27.2%patients with ovarian reserve dysfunction.118 patients had bad living habits,mainly including depression(36.7%),staying up late/sleeping less than 6h(31.4%),and using electronic products longer than 8h(26.6%).2 Distribution of nine constitutions of TCM:the frequency of the main substance types in RSA patients from high to low was:Yang deficiency,qi stagnation,dampness and heat,peace,phlegm and dampness,qi deficiency,Yin deficiency,blood stasis and characteristic substance;After the separation of dual-clamping constitution(Up to 3 constitutions),the frequencies from high to low were:Yang deficiency,qi stagnation,phlegm-dampness,qi deficiency,damp-heat,Yin deficiency,blood stasis,and specific constitution;The main substance distribution of RSA patients with different living habits was different(P=0.023),and the RSA patients with bad living habits were mostly qi stagnation quality and Yang deficiency quality.3 Distribution of Five-pattern personality:the scores of five state personality in RSA patients were lower than the national female norm(P<0.05).The number of fetal stops was related to personality type,and the scores of patients with 3 or more fetal stops were higher in lunar personality dimension(P=0.024).The five-state personality distribution of RSA patients with peaceful constitution and biased constitution was different,and there was a difference in the distribution of lunar personality dimension(P=0.03).The lunar personality was mainly biased constitution.4 Distribution of TCM syndrome types:the frequency of RSA syndrome from high to low was kidney deficiency syndrome(79 cases,54.5%),blood stasis syndrome(33 cases,22.8%),qi and blood weakness syndrome(24 cases,16.6%),and blood heat syndrome(9 cases,6.2%).5 Relationship between Constitution and Five-pattern personality:Shaoyang personality was positively correlated with peace quality(r=0.22,P=0.01),and negatively correlated with Qi deficiency quality and qi stagnation quality,and the correlation was Qi-stagnation quality(r=-0.21,P=0.01)>Qi deficiency quality(r=0.17,P=0.04),suggesting that the higher the score of Shaoyang personality dimension,the more inclined the constitution was to Pinghe quality.The more far away from qi stagnation quality,Qi deficiency quality;There was a negative correlation between Yinyang peace personality and Qi-stagnation quality(r=-0.25,P=0.00),suggesting that the higher the score of Yin-yang peace personality dimension,the more physical constitution away from Qi-stagnation quality;There was a negative correlation between Taiyin personality and peace quality(r=-0.41,P=0.00),and a positive correlation between Taiyin personality and qi deficiency quality,phlegm-dampness quality,blood stasis quality and qi stagnation quality.The correlation was Qi-stagnation quality(r=0.51,P=0.00)>Qi-deficiency quality(r=0.30,P=0.00)>blood-stasis quality(r=0.29,P=0.00)>phlegm-dampness quality(r=0.23,P=0.01),suggesting that the higher the score of Taiyin personality dimension,the more far away from the constitution of peace quality.The more tendency to Qi stagnation quality,Qi deficiency quality,blood stasis quality,phlegm-dampness quality.6 The relationship between syndrome types and TCM constitution:there are differences in constitution distribution among all syndrome types(P=0.02).The constitutions of patients with kidney deficiency syndrome are mostly Yang deficiency quality,those with Qi and blood weakness syndrome are mostly Qi stagnation quality,those with blood heat syndrome are mostly Qi stagnation quality,and those with blood stasis syndrome are mostly Yang deficiency quality.7 The relationship between syndrome types and Five-pattern Personality:There was no difference in the distribution of Five-pattern Personality among all syndrome types(P>0.05).Conclusion1 In tRSAs of TCM constitution,the overall TCM constitution of Early Recurrent Miscarriage patients is mainly Yang deficiency quality and Qi stagnation quality.Qistagnation quality,phlegm-dampness quality and Yang deficiency quality may be susceptible to RSA.RSA patients with bad living habits are easy to form qi stagnation and Yang deficiency.In tRSAs of Five-pattern Personality,the scores of five dimensions of Five-pattern Personality in patients with Early Recurrent Miscarriage were significantly lower than the national female norm,suggesting that the body of RSA patients was in a state of Yin and Yang deficit.Most of the patients with fetal stop more than 3 times had Taiyin personality.In tRSAs of syndrome types,kidney deficiency syndrome was the main syndrome in Early Recurrent Miscarriage,followed by blood stasis syndrome,qi and blood weakness syndrome and blood heat syndrome.2 There is correlation between Five-pattern Personality and TCM constitution.Patients with Taiyin personality are easy to form qi stagnation,blood stasis,phlegmdampness and qi deficiency.Patients with less Yang personality are easy to form a peaceful constitution.The patients with yin-yang and peaceful personality had negative correlation with Qi-stagnation quality.There is a correlation between syndrome types and constitution.Patients with kidney deficiency syndrome and blood stasis syndrome are mostly yang-deficiency constitution.Patients with Qi and blood weakness syndrome and blood heat syndrome mostly have Qi stagnation constitution.The Fivepattern Personality structure is the same among different syndromes.3 RSA is mainly characterized by negative personality and negative constitution,and the disease is mostly deficient.In tRSAs of treatment,traditional Chinese medicine,guiding technique,music therapy,mental and emotional guidance,diet,exercise and other therapies can be used to neutralize negative personality,correct biased constitution,regulate qi and blood,and treat both body and mind,so as to achieve a good pregnancy outcome. |
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