清热解毒方联合补肾祛瘀阶梯治疗改善宫腔粘连分离术后肾虚血瘀证妊娠结局的疗效及对TNF-α和TGF-β水平的影响
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摘要
目的:探讨清热解毒方联合补肾祛瘀阶梯治疗改善宫腔粘连分离术后肾虚血瘀证患者妊娠结局的疗效及对血清肿瘤坏死因子(TNF)-α和转化生长因子(TGF)-β水平的影响。方法:筛选在医院就诊的宫腔粘连患者98例,按数字表法随机分为对照组和治疗组,每组49例。两组给予宫腔镜下宫腔粘连分离术。对照组术后第2天采取雌孕激素人工周期治疗。治疗组在对照组基础上于术后第2天予清热解毒中药灌肠治疗,1剂/d,连续2周。月经复潮后至月经前半周期内服补肾祛瘀方,1剂/d,2次/d,连续治疗3月。比较两组子宫动脉搏动指数(PI)和血流阻力指数(RI)、子宫内膜厚度、宫腔粘连复发、妊娠率及临床疗效。检测两组血清TNF-α和TGF-β水平。结果:治疗后,治疗组RI和PI显著低于对照组,子宫内膜厚度明显大于对照组(P<0.01)。治疗组总有效率为93.88%,显著高于对照组为77.55%(P<0.05)。治疗组患者的宫腔粘连复发率12.24%,显著低于对照组为30.61%(P<0.05)。治疗组患者的妊娠率63.27%,明显高于对照组为38.76%(P<0.05)。治疗后,治疗组血清TNF-α和TGF-β水平明显低于对照组(P<0.01)。结论:清热解毒方联合补肾祛瘀阶梯治疗干预宫腔粘连分离术后肾虚血瘀证患者可提高疗效、妊娠率,降低宫腔粘连复发率,调节体内TNF-α和TGF-β水平可能是其发挥疗效的途径之一。
Objective: To investigate the efficacy of Qingrei Jiedu Decoction and kidney-tonifying and stasis-resolving step therapy improving pregnancy outcome cases after separation of intrauterine adhesions with kidney deficiency and blood stasis syndrome and its effect on serum levels of tumor necrosis factor-α(TNF-α) and transforming growth factor-β(TGF-β). Methods: Ninety-eight cases with intrauterine adhesions were selected and randomly divided them into control group and treatment group with 48 cases in each group. Both groups received hysteroscopic separation of intrauterine adhesions. Control group was given estrogen and progesterone artificial cycle therapy 2 days after operation. Based on control group,cases of treatment group were given with enema treatment of Qingrei Jiedu Decoction(1 dose/d and for 2 weeks) and kidney-tonifying and stasis-resolving step therapy for 3 months after menorrhagia to the first half of menstruation(1 dose/d and twice a day). Blood flow resistance index(RI) and pulsatility index of the uterine artery(PI) of the uterine artery, the endometrial thickness,the recurrence of intrauterine adhesions,the pregnancy rate and the efficacy were compared for both groups. Serum levels of TNF-α and TGF-βwere detected. Results: After treatment, RI and PI of treatment group were obviously lower while the endometrial thickness was higher than those of the control group(P<0.01). The total effective rate was 93.88% of the treatment group,which was evidently higher than 75.55% of the control group(P<0.05). The recurrence rate of the treatment group was 12.24%,which was obviously lower than 30.61% in the control group(P<0.05). The pregnancy rate was 63.27% in the treatment group,which was remarkably higher than 38.76% in the control group(P<0.05). Serum levels of TNF-α and TGF-β of the treatment group were evidently lower than those of the control group(P<0.01). Conclusion: Qingrei Jiedu Decoction and kidney-tonifying and stasis-resolving step therapy improving pregnancy outcome cases after separation of intrauterine adhesions with kidney deficiency and blood stasis syndrome can increase the efficacy and the pregnancy rate,reduce the recurrence rate of intrauterine adhesions and regulating serum levels of TNF-α and TGF-β may be one of ways for the efficacy.
Objective: To investigate the efficacy of Qingrei Jiedu Decoction and kidney-tonifying and stasis-resolving step therapy improving pregnancy outcome cases after separation of intrauterine adhesions with kidney deficiency and blood stasis syndrome and its effect on serum levels of tumor necrosis factor-α(TNF-α) and transforming growth factor-β(TGF-β). Methods: Ninety-eight cases with intrauterine adhesions were selected and randomly divided them into control group and treatment group with 48 cases in each group. Both groups received hysteroscopic separation of intrauterine adhesions. Control group was given estrogen and progesterone artificial cycle therapy 2 days after operation. Based on control group,cases of treatment group were given with enema treatment of Qingrei Jiedu Decoction(1 dose/d and for 2 weeks) and kidney-tonifying and stasis-resolving step therapy for 3 months after menorrhagia to the first half of menstruation(1 dose/d and twice a day). Blood flow resistance index(RI) and pulsatility index of the uterine artery(PI) of the uterine artery, the endometrial thickness,the recurrence of intrauterine adhesions,the pregnancy rate and the efficacy were compared for both groups. Serum levels of TNF-α and TGF-βwere detected. Results: After treatment, RI and PI of treatment group were obviously lower while the endometrial thickness was higher than those of the control group(P<0.01). The total effective rate was 93.88% of the treatment group,which was evidently higher than 75.55% of the control group(P<0.05). The recurrence rate of the treatment group was 12.24%,which was obviously lower than 30.61% in the control group(P<0.05). The pregnancy rate was 63.27% in the treatment group,which was remarkably higher than 38.76% in the control group(P<0.05). Serum levels of TNF-α and TGF-β of the treatment group were evidently lower than those of the control group(P<0.01). Conclusion: Qingrei Jiedu Decoction and kidney-tonifying and stasis-resolving step therapy improving pregnancy outcome cases after separation of intrauterine adhesions with kidney deficiency and blood stasis syndrome can increase the efficacy and the pregnancy rate,reduce the recurrence rate of intrauterine adhesions and regulating serum levels of TNF-α and TGF-β may be one of ways for the efficacy.
引文
[1] 孙玉菡,林奕,孙文洁,等.132例宫腔粘连分离术后患者妊娠的影响因素分析[J].重庆医学,2017,46(2):185-190.
[2] 李维宏,袁虹,胡晓霖.人工流产患者术后宫腔粘连风险知情度调查[J].重庆医学,2017,46(5):665-667.
[3] 毛艳芬,王联欢,刘淑华.中重度宫腔粘连患者宫腔镜术后二次探查的临床价值[J].浙江医学,2018,40(7):739-741.
[4] 吴丹.补肾活血汤对宫腔粘连术后肾虚血瘀患者凝血功能及炎症反应的影响[J].中国实验方剂学杂志,2017,23(9):174-178.
[5] 杨力,吴惠珍,甘海丝.生长激素对重度宫腔黏连患者的治疗效果及对妊娠结局和炎性细胞因子的影响[J].中国医药导报,2018,15(6):84-87.
[6] 周晓景,谭丽,王芳.复方玄驹胶囊对宫腔粘连术后冻融胚胎移植妊娠结局影响[J].中国中西医结合杂志,2017,37(4):426-428.
[7] 张洪涛,翁冬莉.防粘连膜联合助膜养宫汤对肾虚血瘀型重度宫腔粘连术后患者宫腔再粘连、凝血功能及血清TGF-β和TIMP-1的影响[J].现代中西医结合杂志,2018,27(14):1509-1512,1556.
[8] 中华医学会妇产科学分会.宫腔粘连临床诊疗中国专家共识[J].中华妇产科杂,2015,50(12):881-887.
[9] 张玉珍.新编中医妇科学[M].北京:人民军医出版社,2001:128-130.
[10] 中华人民共和国卫生部.中药新药临床研究指导原则:第1辑[S].1993:241-245.
[11] 张小洪,邓雷厉.中西医结合防治宫腔粘连分离术后再粘连疗效观察[J].中国民族民间医药,2015,24(18):79-80.
[12] 林彤,郭玉佳,钟垚,等.中药保留灌肠及微波治疗在体外受精-胚胎移植中宫腔积液及内膜薄的应用[J].福建医科大学学报,2017,51(6):400-403.
[13] 黄晓君,陈静丽.自拟化瘀生新汤灌肠治疗宫腔术后月经过少的疗效分析[J].世界中医药,2016,11(12):2641-2644.
[14] 郑小平,高微微,陆海英,等.补肾助孕汤联合雌孕激素治疗宫腔粘连分离术后患者临床观察[J].新中医,2018,50(5):131-134.
[15] 杨凭翔,陈霞.陈霞教授辨治宫腔粘连经验探赜[J].浙江中医药大学学报,2017,41(10):828-830.
[16] 赵威,王辉霞.通络补肾法联合人工周期防治重度宫腔黏连术后再黏连的临床分析[J].齐齐哈尔医学院学报,2017,38(5):569-570.
[17] 张洪涛,李婧.补肾活血法联合西药治疗对宫腔粘连术后子宫内膜血流及血清炎症因子的影响[J].现代中西医结合杂志,2018,27(11):1175-1178.
[18] 李莉莉,周艳.益母逐瘀汤联合西药治疗宫腔粘连分解术后中重度宫腔粘连临床研究[J].中国中医药信息杂志,2018,25(5):27-31.
[19] 汪华玲,赵小迎.腔球囊联合交联透明质酸钠预防重度宫腔粘连分离术后复发的疗效分析[J].中国计划生育学杂志,2018,26(1):39-42.
[20] 倪燕,程艳芬.透明质酸钠联合双腔球囊在宫腔镜电切术后宫腔粘连中的应用效果[J].浙江创伤外科,2018,23(2):248-249.
[21] 郭罗培,隋摇龙.TGF-β在宫腔粘连纤维化中的研究进展[J].现代妇产科进展,2018,27(5):394-396.
[22] 王华,迟琼,熊石龙,等.金银花提取物对LPS致ARDS大鼠肺炎症影响的研究[J].广东药科大学学报,2017,33(3):379-382.
[23] 汤明杰,叶永山,张旗,等.牡丹皮对内毒素性急性肺损伤大鼠的保护作用[J].环球中医药,2015,8(10):1167-1170.
[24] 李艳丽,胡彦武.紫花地丁抗炎作用及机制研究[J].中国实验方剂学杂志,2012,18(24):244-247.
[25] 宫登辉,江永祥,郑卫红,等.左旋延胡索乙素对化疗痛大鼠痛阈的影响及其在脊髓水平的机理研究[J].中药药理与临床,2013,29(5):27-29.
[26] 毕礼明,陈英兰,陆曙,等.大黄治疗肾脏病安全性探析[J].医学争鸣,2016,7(6):29-32,36.
[27] 赵辉,赵伟.牡丹皮对脂多糖诱导大鼠系膜细胞的保护作用[J].药学研究,2018,37(5):259-261.
[28] 俞静,刘莲,张玥,等.延胡索乙素对大鼠急性放射性肺损伤的保护作用[J].临床与病理杂志,2017,37(1):62-68.
[2] 李维宏,袁虹,胡晓霖.人工流产患者术后宫腔粘连风险知情度调查[J].重庆医学,2017,46(5):665-667.
[3] 毛艳芬,王联欢,刘淑华.中重度宫腔粘连患者宫腔镜术后二次探查的临床价值[J].浙江医学,2018,40(7):739-741.
[4] 吴丹.补肾活血汤对宫腔粘连术后肾虚血瘀患者凝血功能及炎症反应的影响[J].中国实验方剂学杂志,2017,23(9):174-178.
[5] 杨力,吴惠珍,甘海丝.生长激素对重度宫腔黏连患者的治疗效果及对妊娠结局和炎性细胞因子的影响[J].中国医药导报,2018,15(6):84-87.
[6] 周晓景,谭丽,王芳.复方玄驹胶囊对宫腔粘连术后冻融胚胎移植妊娠结局影响[J].中国中西医结合杂志,2017,37(4):426-428.
[7] 张洪涛,翁冬莉.防粘连膜联合助膜养宫汤对肾虚血瘀型重度宫腔粘连术后患者宫腔再粘连、凝血功能及血清TGF-β和TIMP-1的影响[J].现代中西医结合杂志,2018,27(14):1509-1512,1556.
[8] 中华医学会妇产科学分会.宫腔粘连临床诊疗中国专家共识[J].中华妇产科杂,2015,50(12):881-887.
[9] 张玉珍.新编中医妇科学[M].北京:人民军医出版社,2001:128-130.
[10] 中华人民共和国卫生部.中药新药临床研究指导原则:第1辑[S].1993:241-245.
[11] 张小洪,邓雷厉.中西医结合防治宫腔粘连分离术后再粘连疗效观察[J].中国民族民间医药,2015,24(18):79-80.
[12] 林彤,郭玉佳,钟垚,等.中药保留灌肠及微波治疗在体外受精-胚胎移植中宫腔积液及内膜薄的应用[J].福建医科大学学报,2017,51(6):400-403.
[13] 黄晓君,陈静丽.自拟化瘀生新汤灌肠治疗宫腔术后月经过少的疗效分析[J].世界中医药,2016,11(12):2641-2644.
[14] 郑小平,高微微,陆海英,等.补肾助孕汤联合雌孕激素治疗宫腔粘连分离术后患者临床观察[J].新中医,2018,50(5):131-134.
[15] 杨凭翔,陈霞.陈霞教授辨治宫腔粘连经验探赜[J].浙江中医药大学学报,2017,41(10):828-830.
[16] 赵威,王辉霞.通络补肾法联合人工周期防治重度宫腔黏连术后再黏连的临床分析[J].齐齐哈尔医学院学报,2017,38(5):569-570.
[17] 张洪涛,李婧.补肾活血法联合西药治疗对宫腔粘连术后子宫内膜血流及血清炎症因子的影响[J].现代中西医结合杂志,2018,27(11):1175-1178.
[18] 李莉莉,周艳.益母逐瘀汤联合西药治疗宫腔粘连分解术后中重度宫腔粘连临床研究[J].中国中医药信息杂志,2018,25(5):27-31.
[19] 汪华玲,赵小迎.腔球囊联合交联透明质酸钠预防重度宫腔粘连分离术后复发的疗效分析[J].中国计划生育学杂志,2018,26(1):39-42.
[20] 倪燕,程艳芬.透明质酸钠联合双腔球囊在宫腔镜电切术后宫腔粘连中的应用效果[J].浙江创伤外科,2018,23(2):248-249.
[21] 郭罗培,隋摇龙.TGF-β在宫腔粘连纤维化中的研究进展[J].现代妇产科进展,2018,27(5):394-396.
[22] 王华,迟琼,熊石龙,等.金银花提取物对LPS致ARDS大鼠肺炎症影响的研究[J].广东药科大学学报,2017,33(3):379-382.
[23] 汤明杰,叶永山,张旗,等.牡丹皮对内毒素性急性肺损伤大鼠的保护作用[J].环球中医药,2015,8(10):1167-1170.
[24] 李艳丽,胡彦武.紫花地丁抗炎作用及机制研究[J].中国实验方剂学杂志,2012,18(24):244-247.
[25] 宫登辉,江永祥,郑卫红,等.左旋延胡索乙素对化疗痛大鼠痛阈的影响及其在脊髓水平的机理研究[J].中药药理与临床,2013,29(5):27-29.
[26] 毕礼明,陈英兰,陆曙,等.大黄治疗肾脏病安全性探析[J].医学争鸣,2016,7(6):29-32,36.
[27] 赵辉,赵伟.牡丹皮对脂多糖诱导大鼠系膜细胞的保护作用[J].药学研究,2018,37(5):259-261.
[28] 俞静,刘莲,张玥,等.延胡索乙素对大鼠急性放射性肺损伤的保护作用[J].临床与病理杂志,2017,37(1):62-68.