Jin Haijuan, Cheng Junjun, Li Huimin, Huang Wenjuan, Lin Da
Department of Obstetrics and Gynecology, Hangzhou Linping Hospital of Traditional Chinese Medicine, Hangzhou, China.
Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
Medicine (Baltimore). 2025 May 30;104(22):e42654. doi: 10.1097/MD.0000000000042654.
Recurrent spontaneous abortion (RSA) arises from a multifactorial etiology, frequently associated with immune system irregularities. The immunopathological mechanisms underlying miscarriage differ, and immune-mediated abortion can be categorized into autoimmune RSA and alloimmune RSA. Traditional Chinese medicine (TCM) has unique advantages in treating immune-related RSA, but currently lacks systematic studies on TCM syndrome differentiation. This study aims to explore the TCM syndrome characteristics of immune-related RSA patients using cluster analysis, revealing the clinical manifestations and features of different syndromes, to provide theoretical evidence for clinical TCM diagnosis and treatment. This study designed a TCM syndrome information collection form for immune-related RSA and conducted a clinical epidemiological survey of 244 immune-related RSA patients, collecting symptoms, tongue and pulse information, and performing frequency analysis. A hierarchical cluster analysis was performed on variables, using the between-groups linkage method and Squared Euclidean distance to identify distinct syndrome patterns. Based on the clustering results and TCM theory, relevant syndromes were summarized, and the relationship between syndrome distribution, age, and number of miscarriages was further analyzed. The results show that the distribution of syndromes in immune-related RSA is as follows: kidney deficiency and blood-stasis syndrome (57.4%), spleen-kidney yang deficiency syndrome (18.8%), kidney deficiency and internal heat syndrome (12.3%), and kidney deficiency with damp-heat syndrome (11.5%). As age advances, the prevalence of kidney deficiency and blood-stasis syndrome notably escalates. Similarly, an increase in the number of miscarriages correlates with a higher incidence of this syndrome, especially in patients who have experienced more than 3 miscarriages. This study identifies the TCM syndrome classification pattern for immune-related RSA, highlighting that "deficiency," "heat," and "stasis" are the primary etiological factors, with kidney deficiency and blood-stasis syndrome being the most prevalent. The results offer empirical support for clinical TCM syndrome differentiation and treatment, while also establishing a theoretical foundation for TCM-based therapeutic strategies for immune-related RSA.
复发性自然流产（RSA）病因多因素，常与免疫系统异常有关。流产的免疫病理机制各异，免疫介导的流产可分为自身免疫性RSA和同种免疫性RSA。中医在治疗免疫相关RSA方面具有独特优势，但目前缺乏对中医辨证的系统研究。本研究旨在通过聚类分析探讨免疫相关RSA患者的中医证候特征，揭示不同证候的临床表现和特点，为中医临床诊断和治疗提供理论依据。本研究设计了免疫相关RSA的中医证候信息采集表，对244例免疫相关RSA患者进行临床流行病学调查，收集症状、舌象和脉象信息，并进行频次分析。对变量进行分层聚类分析，采用组间连接法和平方欧氏距离来识别不同的证候模式。根据聚类结果和中医理论，总结相关证候，并进一步分析证候分布与年龄、流产次数之间的关系。结果显示，免疫相关RSA的证候分布如下：肾虚血瘀证（57.4%）、脾肾阳虚证（18.8%）、阴虚内热证（12.3%）、肾虚湿热证（11.5%）。随着年龄增长，肾虚血瘀证的患病率显著升高。同样，流产次数增加与该证候的发病率升高相关，尤其是流产3次以上的患者。本研究确定了免疫相关RSA的中医证候分类模式，强调“虚”“热”“瘀”是主要病因，其中肾虚血瘀证最为常见。研究结果为中医临床辨证论治提供了实证支持，也为基于中医的免疫相关RSA治疗策略奠定了理论基础。
