定坤丹联合米非司酮治疗子宫内膜异位症
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摘要
目的探讨定坤丹联合米非司酮对子宫内膜异位症患者术后血管生长及血清肿瘤标志物水平的影响。方法将2017年2月至2018年1月就诊的104例子宫内膜异位症患者,按随机数字表法分为研究组(n=52)和对照组(n=52),全部患者采用腹腔镜病灶切除术治疗。对照组患者在术后采用米非司酮治疗,研究组患者在对照组基础上采用定坤丹治疗,对比两组的治疗效果。检测两组治疗前后血清血管内皮生长因子(VEGF)-A、转化生长因子(TGF)-β1、成纤维细胞生长因子(bFGF)、基质金属蛋白酶(MMP)-9、糖类抗原(CA)125、CA199、抗子宫内膜抗体(EMAb)的水平;检测两组性激素[血清雌二醇(E2)、促卵泡刺激素(FSH)、促黄体生成素(LH)]水平变化。采用彩色多普勒超声检测盆腔包块直径。采用视觉模拟评分法(VAS)评估两组的疼痛程度。记录两组不良反应发生情况。结果研究组的总有效率比对照组高,差异有统计学意义(94.23%vs 80.77%,P=0.038);两组治疗后的VEGF-A、TGF-β1、bFGF、MMP-9、CA125、CA199、EMAb、E2、LH、FSH水平及VAS评分、盆腔包块直径较治疗前均降低(P均<0.05),且研究组均低于对照组(P均<0.05)。两组治疗过程中均无明显不良反应发生。结论定坤丹能提高子宫内膜异位症的疗效,抑制血管生长,降低血清CA125、CA199、EMAb的水平。
Objective To investigate the effects of Dingkundan combined with mifepristone on angioenesis and serum tumor markers in patients with endometriosis after operation.Methods A total of 104 patients with endometriosis,receiving laparoscopic resection from February 2017 to January 2018 were randomly divided into study group and control group(n=52,each).After operation,mifepristone was given in control group,and combined use of Dingkundan and mifepristone was given in study group.Before and after treatment the levels of serum vascular endothelial growth factor A(VEGF-A),transforming growth factor β1(TGF-β1),basic fibroblast growth factor(bFGF),matrix metalloproteinase 9(MMP-9),carbohydrate antigen 125(CA125),carbohydrate antigen 199(CA199),anti-endometrial antibody(EMAb) and sex hormone levels of estrogen(E2),luteinizing hormone(LH) and follicle-stimulating hormone(FSH)were detected respectively;the diameter of pelvic masses was measured by color Doppler ultrasound;the pain degree was evaluated using visual analogue scale(VAS);the occurrence of adverse reactions was recorded in both groups.Results The total effective rate in study group was significantly higher than that in control group(94.23% vs 80.77%,P=0.038).After treatment,the levels of VEGF-A,TGF-β1,bFGF,MMP-9,CA125,CA199,EMAb,E2,LH,FSH and VAS score and pelvic mass diameter of the two groups decreased significantly compared with before treatment(all P<0.05),and the above index values in study group were significantly lower than those in control group after operation(all P<0.05).No obvious adverse reactions occurred in two groups during the treatment.Conclusion Dingkundan can improve the curative effect of endometriosis,inhibit the angioenesis and reduce the levels of serum CA125,CA199 and EMAb.
Objective To investigate the effects of Dingkundan combined with mifepristone on angioenesis and serum tumor markers in patients with endometriosis after operation.Methods A total of 104 patients with endometriosis,receiving laparoscopic resection from February 2017 to January 2018 were randomly divided into study group and control group(n=52,each).After operation,mifepristone was given in control group,and combined use of Dingkundan and mifepristone was given in study group.Before and after treatment the levels of serum vascular endothelial growth factor A(VEGF-A),transforming growth factor β1(TGF-β1),basic fibroblast growth factor(bFGF),matrix metalloproteinase 9(MMP-9),carbohydrate antigen 125(CA125),carbohydrate antigen 199(CA199),anti-endometrial antibody(EMAb) and sex hormone levels of estrogen(E2),luteinizing hormone(LH) and follicle-stimulating hormone(FSH)were detected respectively;the diameter of pelvic masses was measured by color Doppler ultrasound;the pain degree was evaluated using visual analogue scale(VAS);the occurrence of adverse reactions was recorded in both groups.Results The total effective rate in study group was significantly higher than that in control group(94.23% vs 80.77%,P=0.038).After treatment,the levels of VEGF-A,TGF-β1,bFGF,MMP-9,CA125,CA199,EMAb,E2,LH,FSH and VAS score and pelvic mass diameter of the two groups decreased significantly compared with before treatment(all P<0.05),and the above index values in study group were significantly lower than those in control group after operation(all P<0.05).No obvious adverse reactions occurred in two groups during the treatment.Conclusion Dingkundan can improve the curative effect of endometriosis,inhibit the angioenesis and reduce the levels of serum CA125,CA199 and EMAb.
引文
[1] 彭靖,张萌,李桂玲.子宫内膜异位症相关不孕的治疗进展[J].国际生殖健康/计划生育杂志,2017,36(1):82-86.
[2] 张晓兰,陈艳,栾小娜,等.腹腔镜术式治疗子宫内膜异位症有效性和安全性分析[J].中国性科学,2016,25(5):57-59.
[3] 高剑华,陈玉蓉,崔静,等.腹腔镜手术联合米非司酮治疗子宫内膜异位症效果观察[J].山东医药,2017,57(10):72-74.
[4] 何闰华,王文艳,卫兵.定坤丹对子宫内膜异位症模型大鼠的作用[J].安徽医科大学学报,2015,50(11):1693-1695.
[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] 黄俊花,刘明星,陈晓红,等.不同临床病理类型子宫内膜异位症合并不孕患者生育力的研究[J].中国微创外科杂志,2017,17(7):594-598.
[8] 刘淑琴.子宫内膜异位症合并不孕症患者腹腔镜手术后妊娠情况及其影响因素[J].山东医药,2016,12(4):71-72.
[9] 张正宇.米非司酮联合腹腔镜手术对子宫内膜异位症患者血清VEGF、 VEGFR及MIF水平的影响[J].标记免疫分析与临床,2016,23(9):1038-1040.
[10] 吴育宁,许金晶.子宫内膜异位症合并不孕症的中西医结合治疗[J].中国计划生育学杂志,2016,24(11):724-726.
[11] 郁琳,石燕,庄梦斐,等.定坤丹治疗子宫内膜异位症的药理作用与机制[J].生殖与避孕,2016,36(12):963-970.
[12] 刘丹卓,赵新广,尤昭玲.定坤丹组方研究及临床应用现状分析[J].世界中医药,2014,9(8):1108-1110.
[13] 许晓月,骆黎静,卢丹,等.子宫内膜异位症患者血管生成相关基因VEGF和TSP-1 mRNA的表达[J].基因组学与应用生物学,2016,35(1):6-10.
[14] 郭路路,王伟,郝敏.VEGF-A在子宫内膜异位症中的研究进展[J].国际妇产科学杂志,2018,45(1):111-114.
[15] 高桂芹,林琬君,李宝森.子宫内膜异位症患者在位与异位内膜bFGF表达的意义[J].天津医药,2009,37(10):883-884.
[16] 潘孝勇,刘倩如,郭美丽,等.子宫内膜异位症患者MMP-2、MMP-9及其组织抑制因子的表达[J].中国优生与遗传杂志,2016,24(10):73-74.
[17] 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.
[18] 郑芝祥,范馥芳,李俊妹,等.血清CA125和CA199与子宫内膜异位症患者术后妊娠率关系研究[J].中国实用妇科与产科杂志,2016,11(11):1121-1123.
[19] 刘洋,散琴,熊莹莹,等.子宫内膜异位症患者血清CA125、EMAb、ENA-78、EPO、VEGF水平的临床意义[J].中国计划生育学杂志,2017,25(7):479-481.
[2] 张晓兰,陈艳,栾小娜,等.腹腔镜术式治疗子宫内膜异位症有效性和安全性分析[J].中国性科学,2016,25(5):57-59.
[3] 高剑华,陈玉蓉,崔静,等.腹腔镜手术联合米非司酮治疗子宫内膜异位症效果观察[J].山东医药,2017,57(10):72-74.
[4] 何闰华,王文艳,卫兵.定坤丹对子宫内膜异位症模型大鼠的作用[J].安徽医科大学学报,2015,50(11):1693-1695.
[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] 黄俊花,刘明星,陈晓红,等.不同临床病理类型子宫内膜异位症合并不孕患者生育力的研究[J].中国微创外科杂志,2017,17(7):594-598.
[8] 刘淑琴.子宫内膜异位症合并不孕症患者腹腔镜手术后妊娠情况及其影响因素[J].山东医药,2016,12(4):71-72.
[9] 张正宇.米非司酮联合腹腔镜手术对子宫内膜异位症患者血清VEGF、 VEGFR及MIF水平的影响[J].标记免疫分析与临床,2016,23(9):1038-1040.
[10] 吴育宁,许金晶.子宫内膜异位症合并不孕症的中西医结合治疗[J].中国计划生育学杂志,2016,24(11):724-726.
[11] 郁琳,石燕,庄梦斐,等.定坤丹治疗子宫内膜异位症的药理作用与机制[J].生殖与避孕,2016,36(12):963-970.
[12] 刘丹卓,赵新广,尤昭玲.定坤丹组方研究及临床应用现状分析[J].世界中医药,2014,9(8):1108-1110.
[13] 许晓月,骆黎静,卢丹,等.子宫内膜异位症患者血管生成相关基因VEGF和TSP-1 mRNA的表达[J].基因组学与应用生物学,2016,35(1):6-10.
[14] 郭路路,王伟,郝敏.VEGF-A在子宫内膜异位症中的研究进展[J].国际妇产科学杂志,2018,45(1):111-114.
[15] 高桂芹,林琬君,李宝森.子宫内膜异位症患者在位与异位内膜bFGF表达的意义[J].天津医药,2009,37(10):883-884.
[16] 潘孝勇,刘倩如,郭美丽,等.子宫内膜异位症患者MMP-2、MMP-9及其组织抑制因子的表达[J].中国优生与遗传杂志,2016,24(10):73-74.
[17] 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.
[18] 郑芝祥,范馥芳,李俊妹,等.血清CA125和CA199与子宫内膜异位症患者术后妊娠率关系研究[J].中国实用妇科与产科杂志,2016,11(11):1121-1123.
[19] 刘洋,散琴,熊莹莹,等.子宫内膜异位症患者血清CA125、EMAb、ENA-78、EPO、VEGF水平的临床意义[J].中国计划生育学杂志,2017,25(7):479-481.