大黄庶虫虫丸治疗子宫内膜异位症盆腔疼痛气滞血瘀证的临床观察
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摘要
目的:探讨大黄■虫丸治疗子宫内膜异位症盆腔疼痛(气滞血瘀证)的临床效果和其作用机制。方法:将126名患者经区组随机分为对照组64例和观察组62例。两组患者均口服地屈孕酮片,月经周期的第5～25天,1片/次,2次/d。对照组口服散结镇痛胶囊,4粒/次,3次/d,于月经来潮第1天开始服药,经期不停用;观察组口服大黄庶虫虫丸,3 g/次,2次/d,经期不停用。两组患者疗程均为连续治疗3个月经周期。痛经情况采用疼痛视觉模拟评分(VAS),分别于治疗前和治疗后1,2,3个月经周期各评价1次;进行治疗前后症状及体征评分、气滞血瘀证和子宫内膜异位症的专用生存质量评价量表(EHP-5)评分;进行治疗前后血液流变学检测;检测治疗前后基质金属蛋白酶-2(MMP-2),MMP-9,肿瘤坏死因子-α(TNF-α),白细胞介素-1 (IL-1),前列腺素E2(PGE2),前列腺素F2α(PGF2α)和P物质(SP)水平。结果:经秩和检验,观察组疾病疗效优于对照组(Z=2. 198,P <0. 05);观察组在治疗后1,2,3个月经周期VAS评分均低于对照组(P <0. 01);治疗后观察组症状、体征评分、气滞血瘀证评分和EHP-5评分均低于对照组(P <0. 01);观察组血液流变学指标[全血黏度(高切、低切)、血浆黏度、红细胞沉降率和血小板聚集率]的改善均优于对照组(P <0. 01);观察组患者血清MMP-2,MMP-9,TNF-α,IL-1,PGF2α和SP水平均低于对照组,PGE2高于对照组(P <0. 01)。结论:在孕激素治疗的基础上,采用大黄庶虫虫丸治疗内膜异位症盆腔疼痛(气滞血瘀证)患者可进一步的减轻盆腔疼痛相关症状,提高了患者生活质量和临床疗效,并具有调节前列腺素、基质金属蛋白酶及促炎因子水平等作用。
Objective: To discuss the clinical effect of Dahuang Zhechong Wan on pelvic pain caused by endometriosis with Qi stagnation and blood stasis syndrome and study the mechanism of action. Method: One hundred and twenty-six patients were randomly divided into control group( 64 cases) and observation group( 62 cases) by random number table. Both groups' patients got Duphaston from the 5 thto 25 thdays of menstrual cycle,1 tablet/day,2 times/days. Patients in control group got Sanjie Zhentong Jiaonang at the first day of menstruation,4 grains/time,3 times/days. Patients in observation group got Dahuang Zhechong Wan,3 g/time,2 times/days.The treatment in two groups continued for 3 menstrual cycles. Before treatment and at the first,second and third menstrual cycles after the treatment,visual analogue score( VAS) of pain was used for dysmenorrheal. Before AND after the treatment,scores of symptoms,signs,Qi stagnation and blood stasis syndrome and endometriosis were scored by endometriosis health profile-5( EHP-5). And hemorheology was detected, and levels of matrix metalloproteinases-2( MMP-2),MMP-9,tumor necrosis factor-α( TNF-α),interleukin-1( IL-1),prostaglandin E2( PGE2),prostaglandin F2α( PGF2α) and substance P( SP) were detected. Result: By rank sum test,the clinical effect of disease in observation group was better than that in control group( Z = 2. 198,P < 0. 05). At the first,second and third menstrual cycles,score of VAS was lower than that in control group( P < 0. 01). After treatment,scores of symptoms,signs,Qi stagnation and blood stasis syndrome and EHP-5 were lower than those in control group( P < 0. 01). And the ameliorate of hemorheological indices,such as the whole blood viscosity( high shear and low shear),plasma viscosity,erythrocyte sedimentation rate and platelet aggregation rate,were all better than those in control group( P < 0. 01). And levels of MMP-2,MMP-9,TNF-α,IL-1,PGF2αand SP were lower than those in control group( P < 0. 01),whereas level of PGE2 was higher than that in control group( P < 0. 01).Conclusion: In addition to treatment of progestogen,Dahuang Zhechong Wan can relieve pelvic pain,improve quality of life and clinical effect, and regulate levels of prostaglandins, matrix metalloproteinases and proinflammatory factors.
Objective: To discuss the clinical effect of Dahuang Zhechong Wan on pelvic pain caused by endometriosis with Qi stagnation and blood stasis syndrome and study the mechanism of action. Method: One hundred and twenty-six patients were randomly divided into control group( 64 cases) and observation group( 62 cases) by random number table. Both groups' patients got Duphaston from the 5 thto 25 thdays of menstrual cycle,1 tablet/day,2 times/days. Patients in control group got Sanjie Zhentong Jiaonang at the first day of menstruation,4 grains/time,3 times/days. Patients in observation group got Dahuang Zhechong Wan,3 g/time,2 times/days.The treatment in two groups continued for 3 menstrual cycles. Before treatment and at the first,second and third menstrual cycles after the treatment,visual analogue score( VAS) of pain was used for dysmenorrheal. Before AND after the treatment,scores of symptoms,signs,Qi stagnation and blood stasis syndrome and endometriosis were scored by endometriosis health profile-5( EHP-5). And hemorheology was detected, and levels of matrix metalloproteinases-2( MMP-2),MMP-9,tumor necrosis factor-α( TNF-α),interleukin-1( IL-1),prostaglandin E2( PGE2),prostaglandin F2α( PGF2α) and substance P( SP) were detected. Result: By rank sum test,the clinical effect of disease in observation group was better than that in control group( Z = 2. 198,P < 0. 05). At the first,second and third menstrual cycles,score of VAS was lower than that in control group( P < 0. 01). After treatment,scores of symptoms,signs,Qi stagnation and blood stasis syndrome and EHP-5 were lower than those in control group( P < 0. 01). And the ameliorate of hemorheological indices,such as the whole blood viscosity( high shear and low shear),plasma viscosity,erythrocyte sedimentation rate and platelet aggregation rate,were all better than those in control group( P < 0. 01). And levels of MMP-2,MMP-9,TNF-α,IL-1,PGF2αand SP were lower than those in control group( P < 0. 01),whereas level of PGE2 was higher than that in control group( P < 0. 01).Conclusion: In addition to treatment of progestogen,Dahuang Zhechong Wan can relieve pelvic pain,improve quality of life and clinical effect, and regulate levels of prostaglandins, matrix metalloproteinases and proinflammatory factors.
引文
[1]孔东丽,段华.子宫内膜异位症病灶与盆腔疼痛的关系[J].实用妇产科杂志,2015,31(9):641-642.
[2]刘开江.子宫内膜异位症疼痛的伴随症状与治疗[J].实用妇产科杂志,2015,31(9):650-652.
[3]徐冰.子宫内膜异位症疼痛长期药物治疗[J].实用妇产科杂志,2015,31(9):648-650.
[4]李宛真,魏薇.子宫内膜异位症疼痛的药物治疗现状[J].医学综述,2017,23(11):2230-2235.
[5]刘洁云,郭洁,吴雅俊,等.琥珀散加减辨治子宫内膜异位症疼痛(血瘀证)的疗效作用机制[J].中国实验方剂学杂志,2017,23(17):205-210.
[6]刘志霞,刘志宏.子宫内膜异位症盆腔疼痛病机探讨[J].中医学报,2018,33(10):1962-1965.
[7]冬梅,杨海厚.大黄庶虫虫丸异病同治举隅[J].新疆中医药,2009,27(5):81-83.
[8]文玥,王政,齐晓峰,等.大黄庶虫虫丸对气虚血瘀大鼠TNF-α和NF-κB/IκB-α的影响[J].河北中医药学报,2016,31(3):1-4.
[9]李富娟.大黄庶虫虫胶囊治疗子宫内膜异位症[J].中国实验方剂学杂志,2013,19(4):297-299.
[10]中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊断与治疗规范[J].中华妇产科杂志,2007,42(9):645-648.
[11]中华中医药学会.中医妇科常见病诊疗指南[M].北京:中国中医药出版社,2012:120-123.
[12]Goshtasebi A,Nematollahzadeh M,Hariri F Z,et al.The short form endometriosis health profile(EHP-5):translation and validation study of the Iranian version[J]. J Ovarian Res,2011,4(1):11-15.
[13]朱丽波,张信美.子宫内膜异位症疼痛发病机制及目前治疗问题探讨[J].中国实用妇科与产科杂志,2013,29(1):11-14.
[14]孔东丽.子宫内膜异位症保守性手术后长期用药预防复发的研究进展[J].实用妇产科杂志,2015,31(1):19-22.
[15]宋景艳,孙振高,张兴兴,等.子宫内膜异位症病机核心“血瘀证”本质的现代研究及进展[J].中国性科学,2017,26(11):81-84.
[16]余燚薇,赵瑞华,张润顺,等.子宫内膜异位症中医证候要素分布特点多元分析[J].环球中医药,2017,10(11):1242-1247.
[17]周艳,刘明珠.宫瘤消胶囊对子宫内膜异位症气滞血瘀证血管生成机制的影响[J].中国实验方剂学杂志,2017,23(21):200-205.
[18]翁伟玲,傅杰英.傅杰英从体质角度运用大黄庶虫虫丸经验[J].长春中医药大学学报,2017,33(2):232-234.
[19]张鹏,姚吉龙.子宫内膜异位症相关疼痛发病机制的研究进展[J].肿瘤预防与治疗,2015,28(3):179-182.
[20]刘芳,朱芝玲.神经及其他因子在子宫内膜异位性疾病疼痛中作用的研究进展[J].复旦学报:医学版,2014,41(2):274-277.
[2]刘开江.子宫内膜异位症疼痛的伴随症状与治疗[J].实用妇产科杂志,2015,31(9):650-652.
[3]徐冰.子宫内膜异位症疼痛长期药物治疗[J].实用妇产科杂志,2015,31(9):648-650.
[4]李宛真,魏薇.子宫内膜异位症疼痛的药物治疗现状[J].医学综述,2017,23(11):2230-2235.
[5]刘洁云,郭洁,吴雅俊,等.琥珀散加减辨治子宫内膜异位症疼痛(血瘀证)的疗效作用机制[J].中国实验方剂学杂志,2017,23(17):205-210.
[6]刘志霞,刘志宏.子宫内膜异位症盆腔疼痛病机探讨[J].中医学报,2018,33(10):1962-1965.
[7]冬梅,杨海厚.大黄庶虫虫丸异病同治举隅[J].新疆中医药,2009,27(5):81-83.
[8]文玥,王政,齐晓峰,等.大黄庶虫虫丸对气虚血瘀大鼠TNF-α和NF-κB/IκB-α的影响[J].河北中医药学报,2016,31(3):1-4.
[9]李富娟.大黄庶虫虫胶囊治疗子宫内膜异位症[J].中国实验方剂学杂志,2013,19(4):297-299.
[10]中华医学会妇产科学分会子宫内膜异位症协作组.子宫内膜异位症的诊断与治疗规范[J].中华妇产科杂志,2007,42(9):645-648.
[11]中华中医药学会.中医妇科常见病诊疗指南[M].北京:中国中医药出版社,2012:120-123.
[12]Goshtasebi A,Nematollahzadeh M,Hariri F Z,et al.The short form endometriosis health profile(EHP-5):translation and validation study of the Iranian version[J]. J Ovarian Res,2011,4(1):11-15.
[13]朱丽波,张信美.子宫内膜异位症疼痛发病机制及目前治疗问题探讨[J].中国实用妇科与产科杂志,2013,29(1):11-14.
[14]孔东丽.子宫内膜异位症保守性手术后长期用药预防复发的研究进展[J].实用妇产科杂志,2015,31(1):19-22.
[15]宋景艳,孙振高,张兴兴,等.子宫内膜异位症病机核心“血瘀证”本质的现代研究及进展[J].中国性科学,2017,26(11):81-84.
[16]余燚薇,赵瑞华,张润顺,等.子宫内膜异位症中医证候要素分布特点多元分析[J].环球中医药,2017,10(11):1242-1247.
[17]周艳,刘明珠.宫瘤消胶囊对子宫内膜异位症气滞血瘀证血管生成机制的影响[J].中国实验方剂学杂志,2017,23(21):200-205.
[18]翁伟玲,傅杰英.傅杰英从体质角度运用大黄庶虫虫丸经验[J].长春中医药大学学报,2017,33(2):232-234.
[19]张鹏,姚吉龙.子宫内膜异位症相关疼痛发病机制的研究进展[J].肿瘤预防与治疗,2015,28(3):179-182.
[20]刘芳,朱芝玲.神经及其他因子在子宫内膜异位性疾病疼痛中作用的研究进展[J].复旦学报:医学版,2014,41(2):274-277.