大黄蛰虫胶囊联合曲普瑞林治疗子宫内膜异位症的临床研究
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摘要
目的探讨大黄蛰虫胶囊联合注射用醋酸曲普瑞林治疗子宫内膜异位症的临床疗效。方法选取2017年1月—2018年2月山东中医药大学第二附属医院收治的子宫内膜异位症患者90例作为研究对象,根据随机数字表法将患者分为对照组和治疗组,每组各45例。对照组于月经来潮第1天肌肉注射注射用醋酸曲普瑞林,1支/次,1次/4周。治疗组在对照组治疗的基础上口服大黄蛰虫胶囊,0.9 g/次,2次/d。两组患者均持续治疗12周。观察两组患者的临床疗效,比较两组治疗前后囊肿直径、视觉模拟(VAS)评分、血液流变学指标和血清细胞因子水平。结果治疗后,对照组和治疗组的总有效率分别为75.56%、91.11%,两组比较差异有统计学意义(P<0.05)。治疗后,两组患者VAS评分显著降低、囊肿直径显著缩小,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗后治疗组上述指标均明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组全血高切黏度、血浆比黏度、红细胞聚集指数、纤维蛋白原水平均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗组血液流变学指标显著低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组血清基质金属蛋白酶-3(MMP-3)、血管内皮生长因子(VEGF)、转化生长因子-β1(TGF-β1)、白细胞介素-8(IL-8)水平均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗后治疗组血清细胞因子水平明显低于对照组,两组比较差异具有统计学意义(P<0.05)。结论大黄蛰虫胶囊联合注射用醋酸曲普瑞林治疗子宫内膜异位症疗效确切,能改善患者血液流变学指标和血清细胞因子水平,减轻疼痛,缩小异位病灶体积,具有一定的临床推广应用价值。
Objective To investigate the clinical efficacy of Dahuang Zhechong Capsules combined with Triptorelin Acetate for injection in treatment of endometriosis. Methods Patients(90 cases) with endometriosis in the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2017 to February 2018 were randomly divided into control and treatment groups, and each group had 45 cases. Patients in the control group were im administered with Triptorelin Acetate for injection at the first day of menstruation, 1 tube/time, once every 4 weeks. Patients in the treatment group were po administered with Dahuang Zhechong Capsules on the basis of the control group, 0.9 g/time, twice daily. Patients in two groups were treated for 12 weeks. After treatment, the clinical efficacy was evaluated, the cyst diameter, the VAS score, hemorheological indexes, and the serum cytokine levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 75.56% and 91.11%, respectively, and there were differences between two groups(P < 0.05). After treatment, the VAS scores in two groups were significantly reduced, and the cyst diameters were significantly decreased, and there were differences in the same group(P < 0.05). And these indexes in the treatment group were significantly lower than those in the control group(P < 0.05) After treatment, the levels of whole blood viscosity, plasma viscosity, erythrocyte aggregation index, and fibrinogen in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And the levels of hemorheological indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). After treatment, MMP-3, VEGF, TGF-β1 and IL-8 levels in two groups were significantly decreased, and there were differences in the same group(P < 0.05). And the serum cytokine levels in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). Conclusion Dahuang Zhechong Capsules combined with Triptorelin Acetate for injection has significant clinical effect in treatment of endometriosis, can improve hemorheological indexes and the serum cytokine levels, relieve the pain, and reduce the volume of ectopic lesions, which has a certain clinical application value.
Objective To investigate the clinical efficacy of Dahuang Zhechong Capsules combined with Triptorelin Acetate for injection in treatment of endometriosis. Methods Patients(90 cases) with endometriosis in the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2017 to February 2018 were randomly divided into control and treatment groups, and each group had 45 cases. Patients in the control group were im administered with Triptorelin Acetate for injection at the first day of menstruation, 1 tube/time, once every 4 weeks. Patients in the treatment group were po administered with Dahuang Zhechong Capsules on the basis of the control group, 0.9 g/time, twice daily. Patients in two groups were treated for 12 weeks. After treatment, the clinical efficacy was evaluated, the cyst diameter, the VAS score, hemorheological indexes, and the serum cytokine levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 75.56% and 91.11%, respectively, and there were differences between two groups(P < 0.05). After treatment, the VAS scores in two groups were significantly reduced, and the cyst diameters were significantly decreased, and there were differences in the same group(P < 0.05). And these indexes in the treatment group were significantly lower than those in the control group(P < 0.05) After treatment, the levels of whole blood viscosity, plasma viscosity, erythrocyte aggregation index, and fibrinogen in two groups were significantly decreased, and the difference was statistically significant in the same group(P < 0.05). And the levels of hemorheological indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). After treatment, MMP-3, VEGF, TGF-β1 and IL-8 levels in two groups were significantly decreased, and there were differences in the same group(P < 0.05). And the serum cytokine levels in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P < 0.05). Conclusion Dahuang Zhechong Capsules combined with Triptorelin Acetate for injection has significant clinical effect in treatment of endometriosis, can improve hemorheological indexes and the serum cytokine levels, relieve the pain, and reduce the volume of ectopic lesions, which has a certain clinical application value.
引文
[1]崔轶凡,李培硕,郝世凤,等.基于流行病学调查论子宫内膜异位症证候类型的特点[J].中国中医基础医学杂志,2014,20(11):1531-1533.
[2]杨建敏.曲普瑞林注射剂联合孕三烯酮胶囊治疗子宫内膜异位症的临床研究[J].中国临床药理学杂志,2018,34(3):257-259.
[3]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.
[4]李富娟.大黄蛰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.
[5]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.
[6]王曼.子宫内膜异位症的中西医结合研究和诊疗标准[J].浙江中西医结合杂志,2002,12(5):265-267.
[7]严广斌.视觉模拟评分法[J].中华关节外科杂志:电子版,2014,8(2):34.
[8]邓丽娜,郭海霞,张英,等.克龄蒙结合曲普瑞林对子宫内膜异位症血清性激素及不良反应的影响[J].中国临床研究,2018,31(3):377-379.
[9]张雪芝,韩延华,王雪莲,等.子宫内膜异位症相关信号通路及中医药治疗对策的研究进展[J].世界中西医结合杂志,2017,12(6):877-880.
[10]武彦舒,刘继梅.大黄蛰虫丸联合复方醋酸棉酚片对子宫内膜异位症腹腔镜术后患者血清学的影响[J].中国中医药信息杂志,2017,24(12):26-29.
[11]岳庆阳,解芳,张丽红,等.血清MMP-3和TIMP-1水平在子宫内膜异位症诊断中的意义[J].临床误诊误治,2013,26(6):83-85.
[12]黄丽霞,马利国.子宫内膜异位症患者白细胞介素-8的变化与复发的关系[J].海南医学,2016,27(9):1395-1397.
[13]易金玲,沈艳丽,冯文广,等.子宫内膜异位症患者异位内膜组织中mi R-556-3p、VEGF表达变化[J].山东医药,2016,56(7):50-52.
[14]宋宝杰,吕敬媛,邢天容,等.丝氨酸蛋白酶A3和转化生长因子-β在子宫内膜异位症患者中的表达及临床意义[J].新乡医学院学报,2016,33(3):204-207.
[15]赵英.子宫内膜异位症不同证型与血液流变学关系初步探讨[J].河北中医药学报,2014,29(1):11-12.
[2]杨建敏.曲普瑞林注射剂联合孕三烯酮胶囊治疗子宫内膜异位症的临床研究[J].中国临床药理学杂志,2018,34(3):257-259.
[3]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.
[4]李富娟.大黄蛰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.
[5]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.
[6]王曼.子宫内膜异位症的中西医结合研究和诊疗标准[J].浙江中西医结合杂志,2002,12(5):265-267.
[7]严广斌.视觉模拟评分法[J].中华关节外科杂志:电子版,2014,8(2):34.
[8]邓丽娜,郭海霞,张英,等.克龄蒙结合曲普瑞林对子宫内膜异位症血清性激素及不良反应的影响[J].中国临床研究,2018,31(3):377-379.
[9]张雪芝,韩延华,王雪莲,等.子宫内膜异位症相关信号通路及中医药治疗对策的研究进展[J].世界中西医结合杂志,2017,12(6):877-880.
[10]武彦舒,刘继梅.大黄蛰虫丸联合复方醋酸棉酚片对子宫内膜异位症腹腔镜术后患者血清学的影响[J].中国中医药信息杂志,2017,24(12):26-29.
[11]岳庆阳,解芳,张丽红,等.血清MMP-3和TIMP-1水平在子宫内膜异位症诊断中的意义[J].临床误诊误治,2013,26(6):83-85.
[12]黄丽霞,马利国.子宫内膜异位症患者白细胞介素-8的变化与复发的关系[J].海南医学,2016,27(9):1395-1397.
[13]易金玲,沈艳丽,冯文广,等.子宫内膜异位症患者异位内膜组织中mi R-556-3p、VEGF表达变化[J].山东医药,2016,56(7):50-52.
[14]宋宝杰,吕敬媛,邢天容,等.丝氨酸蛋白酶A3和转化生长因子-β在子宫内膜异位症患者中的表达及临床意义[J].新乡医学院学报,2016,33(3):204-207.
[15]赵英.子宫内膜异位症不同证型与血液流变学关系初步探讨[J].河北中医药学报,2014,29(1):11-12.