宫宁颗粒治疗IUD出血副反应的临床观察及对大鼠子宫血管构筑影响的研究
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摘要
目的:观察宫宁颗粒治疗瘀热互结型IUD出血副反应的临床疗效并探讨其作用机理。方法:1.临床研究共纳入患者119例,其中症属瘀热互结型IUD出血副反应患者99例(随机分为宫宁颗粒治疗组50例、消炎痛治疗组49例,均治疗1个疗程),无IUD避孕且月经正常的患者20例,为空白对照组。观察总体疗效、中医症候及子宫内膜组织学变化。2.动物实验将实验大鼠随机分为7组:假手术组、模型组、宫宁大剂量组、宫宁中剂量组、宫宁小剂量组、消炎痛组、空白对照组,每组8只。观察宫宁颗粒对大鼠子宫血管构筑变化的影响。结果:1.治疗组治疗瘀热互结型IUD出血副反应的总有效率为90.00%,对照组总有效率为71.42%,两组比较有显著性差异(p<0.05)。2.在中医症候改善方面上,宫宁组有效率为94.00%,消炎痛组为65.31%,两组比较有显著性差异(p<0.01)。3.在调经方面,宫宁组有效率为94%,消炎痛组为77.55%,两组比较有显著性差异(p<0.05)。4.宫宁颗粒可改善患者子宫内膜表浅微血管扩张,内皮细胞变性,基底膜不完整及管壁破裂,减少血栓形成,改善螺旋动脉扩张及平滑肌细胞排列紊乱。5.宫宁颗粒能明显改善置IUD大鼠子宫血管构筑的异常改变。结论:宫宁颗粒治疗瘀热互结型IUD出血副反应有显著疗效,对瘀热互结型IUD出血副反应患者子宫内膜血管损伤有保护和修复作用,能明显改善置IUD大鼠子宫血管构筑的异常改变。
Objective:To investigate the clinical curative effect and mechanism of Gongning granules in treating patients with Endometrorrhagia caused by IUD-wearing diagnosed combination of stasis and heat syndrome. Methods:1.Clinical Study Bring into 119 cases of suffers altogether, 99 cases of them belong to combination of stasis and heat syndrome of Endometrorrhagia caused by IUD-wearing diagnosed (divided into Indomethacin treatment group with 49 cases of suffers and Gongning granules treatment group with 50 cases of suffers, both treated 1 course of treatment), 20 cases of them belong to blank comparison group without IUD contraception and menstruating normally. Observe total curative effect, herbalist doctor syndromes and endometrial histology changes. 2. The animal experiment All the rats for the experiment were divided into 7 groups:the pseudo-operative group,the IUD-insert model group,the high dose group of Gongning granules,the middle dose group of Gongning granules,the low dose group of Gongning granules,Indomethacin granules control group,the normal group , each group having 8 rats. Observe the influence of Gongning granules to the uterus vessel construct of the rats. Results:1.The rate of total curative effect which treatment group treated the patients with Endometrorrhagia caused by IUD-wearing diagnosed combination of stasis and heat syndrome was 90.00%,and the rate of total curative effect of the control group was 71.42%,the two groups were different(p<0.05). 2. In improving the TCM symptom ,The rate of effect which Gongning granules group was 94.00%,and the indomethacin group was 65.31%, the two groups were different(p<0.01). 3. In regualting menstruation, The rate of effect which Gongning granules group was 94.00%,and the indomethacin group was 77.55%, the two groups were different(p<0.05). 4.Gongning granules could improve superficial capillary vessel anapetia of Endometria, endothelial cell degeneration, basal membrane unintegrity and vessel wall disrupt,could decrease thromb, improve arteriae helicinae broaden and arrange derangement of contractile fiber cells. 5. Gongning Granules could obviously improve the abnormal transform of Endometrial angioarchitecture of IUD-wearing rats. Conclusion: Gongning Granules has great effect in treating Endometrorrhagia caused by IUD-wearing diagnosed combination of stasis and heat syndrome,can protect and restoring Endometrial blood vessel harm of Endometrorrhagia caused by IUD-wearing diagnosed , could obviously improve the abnormal transform of Endometrial angioarchitecture of IUD-wearing rats.
引文
[1]庄留琪.中华妇产科杂志.宫内节育器及其使用的研究进展,1995;30(9):516-518.
    [2]张玉珍.中医妇科学.第 1 版.北京:中国中医药出版社,2002;350-351.
    [3]张烨,尤昭玲,文乐兮,等.宫环Ⅱ号胶囊对宫环出血患者子宫内膜形态学的影响.中医药学刊,2004;22(7):1227.
    [4]尤昭玲,张烨 ,雷磊,等.宫环Ⅱ号胶囊对宫环出血患者血管舒缩因子的影响.中国中医药信息杂志,2004;11(4):290.
    [5]刘瑞芬,李继风,栾跃芳.宫宁颗粒剂治疗使用宫内节育器出血副反应的临床研究.中医杂志,1998;5(11):292.
    [6]尤昭玲.中西医结合妇科学(全国高等中医药院校中西医结合专业系列教材).第1 版.北京:中国中医药出版社,2001;434 -436.
    [7]王永炎,王耀廷.今日中医妇科.第 1 版.北京:人民卫生出版社,2000;2-3.
    [8]郑筱萸.中药新药临床研究指导原则·中药新药治疗月经不调指导原则.北京:中国医药科技出版社,2002;第一版:240-241.
    [9]刘瑞芬,李继风,栾跃芳等.环安散防治宫内节育器致月经异常的疗效观察.中国中西医结合杂志,1994;14(6):340-341.
    [10]赵淑敏,孔祥玉,马泉.改良单宁酸-氯化铁法媒染子宫血管的实验研究.中国临床解剖学杂志,2003;21(6):614.
    [11]陈钢,薛红,孟宪丽,等.柴胡止血液对置含铜 IUD 家兔宫腔液 PGI2 和 TXB2含量的影响.中国计划生育学杂志,1999;(7):297-299.
    [12] 赵淑敏,孔祥玉,马泉.改良单宁酸-氯化铁法媒染子宫血管的实验研究.中国临床解剖学杂志,2003,21(6):614.
    [13]赵淑敏,刘瑞荣,孔祥玉.应用单宁酸—氯化铁法观察大鼠子宫血管构筑.中国计划生育杂志,2003;89(3):154~155.
    [14]张玉珍.中医妇科学.第 1 版.北京:中国中医药出版社,2002;350-351.
    [15]刘瑞芬.中医治疗宫内节育器引起异常子宫出血的研究概况.山东中医学院学报1995;19(3):216-217.
    [16]陈钢,李青,薛红等.柴胡止血液治疗宫内节育器所致子宫出血的临床研究.成都中医药大学学报.1999;22(4):8-9.
    [17]刘爱华.对放置宫内节育器后经期延长 30 例的治疗体会.上海中医药杂志,1992;(11):19.
    [18]尤昭玲,王若光.宫内节育器引起异常子宫出血中医治疗评述.湖南中医药导报,1998;4(3):10.
    [19]雷磊,孟延兵,尤昭玲.中医药防治 IUD 出血副反应的思路与方法.湖南中医药导报,2001;7(3)101-102.
    [20]王桂敏,郑淑蓉.甾体激素与子宫内膜出血.生殖与避孕,1996;16(4):248-250.
    [21]刘昌官,李恕香,刘晓瑷,等.消炎痛宫内节育器对大鼠和兔子宫内膜影响的形态学观察.生殖医学杂志,1998;7(2):80.
    [22]潘俊峰,余玉琳,陈桂英,等.宫内节育器致异常出血子宫内膜止血反应的形态学改变.中华妇产科杂志,1995;30(9):526-527.
    [23]刘志成,陈湫波,倪秀生.放置γCuI 和 TCu220C 宫内节育器前后子宫内膜螺旋动脉形态计量学研究,1998;33(4):232.[17] 潘俊峰,余玉琳,陈桂英,等.宫内节育器致异常出血子宫内膜止血反应的形态学改变.中华妇产科杂志,1995;30(9):526-527.
    [24]黄丽丽,陈凌钧,陈湫波,等.放置宫内节育器后子宫内膜螺旋动脉的三维空间形态.中华妇产科杂志,1996;31(9):523-524.
    [25]曹泽毅.中华妇产科学.第 1 版.北京:人民卫生出版社,2000.2407-2408.
    [26]Schwi S E L,Toppozada M,Kamel et al.Prostaglandins and cellular reaction in uterine flushing.I.Effect of IUD insertion.Adv Contracept,1987;3:241.
    [27]Shaw S T Jr,Macaulay L K,Sun N C et al.Changes of plasminogen activator in human uterine tissue induced by intrauterine contraceptive devices.Contraception,1983;27:131.
    [1]孙珊,姚康德.宫内节育器的九十年[J].生殖与避孕,1992;12(6):7
    [2]唐良萏,刘淑文.宫内节育器的并发症及防治.中国实用妇科与产科杂志.2001;17(9):523-525
    [3]张玉珍.中医妇科学.第 1 版.北京:中国中医药出版社,2002;350-351.
    [4]刘瑞芬.中医治疗宫内节育器引起异常子宫出血的研究概况.山东中医学院学报1995;19(3):216-217.
    [5]陈钢,李青,薛红等.柴胡止血液治疗宫内节育器所致子宫出血的临床研究.成都中医药大学学报.1999;22(4):8-9.
    [6]刘爱华.对放置宫内节育器后经期延长 30 例的治疗体会.上海中医药杂志,1992;(11):19.
    [7]尤昭玲,王若光.宫内节育器引起异常子宫出血中医治疗评述.湖南中医药导报,1998;4(3):10.
    [8]雷磊,孟延兵,尤昭玲.中医药防治 IUD 出血副反应的思路与方法.湖南中医药导报,2001;7(3)101-102.
    [9]曹泽毅.中华妇产科学.第 1 版.北京:人民卫生出版社,2000;2407-2408.
    [10]Sheppard B L,Phil D.Endometrial morphological changes in IUD users:review.Contraception,1987;36:1.
    [11]陈文静,沈继云,周洁玲等.观察串铜 394 和 Tcu220cIUD 对人子宫内膜形态学影响的初步观察.同济医科大学学报,1997;26(5):394-396.
    [12]刘志成,陈湫波,倪秀生.放置γCuI 和 TCu220C 宫内节育器前后子宫内膜螺旋动脉形态计量学研究,1998;33(4):232.
    [13]朱蓬第,刘晓群,罗宏志等.左旋 18 甲基炔诺酮 T 型宫内节育器对子宫内膜血管内皮细胞因子Ⅷ活性的影响.生殖与避孕,1994;14(6),416-421.
    [14]陈刚,薛红,周宜等.柴胡止血液对置含铜节育器大鼠子宫组织基质金属蛋白酶-9 和金属蛋白酶组织抑制物-1 及内皮素和一氧化氮的影响.中国计划生育杂志,2003;11:658.
    [15]曹泽毅.中华妇产科学.第 1 版.北京:人民卫生出版社,2000;2394-2398.
    [16]Salmi A,Pakarinen P,Peltola AM,et al.The effect of intrauterine levonorgestrel use on the expressionof c-JUN,oestrogen receptor,progesterone receptors and Ki-67 in human endometrium.Mol Hum Reprod,1998;4:1110-1115.
    [17]Toyoski M,Jeffrey R,Horowitz BS,et al.Vascular endothelial growth faxtor/Vasculat permeability factor enhances vascular permeability via nitric oxide and prostacyclin.Circulation,1998;97:99-107.
    [18]张玉珍.中医妇科学.第 1 版.北京:中国中医药出版社,2002;350-351.
    [19]刘瑞芬.中医治疗宫内节育器引起异常子宫出血近况.山东中医杂志,1995;19(3):215-216.
    [20]朱颖,李军.安环止血汤治疗宫内节育器致异常出血.中国中医急症,2002;11(1):23.
    [21]李萍,郑秋萍.清肝止淋汤治疗放环后经期延长 56 例.实用中医药杂志,2003;19(3):133.
    [22]汤艳秋.龟鹿固冲汤治疗宫内节育器放置后月经失调 200 例.黑龙江中医药,2002;(1):32.
    [23]刘瑞芬,李继风,栾跃芳等.环安散防治宫内节育器致月经异常的疗效观察.中国中西医结合杂志,1994;14(6):340-341.
    [24]尤昭玲 ,张烨 ,雷磊等.宫环Ⅱ号胶囊对宫环出血患者血管舒缩因子的影响.中国中医药信息杂志,2004;11(4):290.
    [25]尤昭玲,左诗慧,徐祥英等.葆妇欣治疗带铜 IUD 出血副反应的临床观察.中国计划生育学杂志,1998;39(7):325-326.
    [26]黄学惠,李武,董文漪等.宫血宁防治宫内节育器所致子宫出血.现代中西医结合杂志,2002;11(6)3:485-486.
    [27]李文华,宋菊先,闫金凤等.针刺孔最穴治疗放置宫内节育器出血 26 例.中国针灸,1997;(8):478.
    [28]吴兆利.针刺对置 IUD 导致子宫出血者血浆 PG 的影响.辽宁中医杂志,2001;28(3):173.
    [29]付灵梅,尤昭玲.环血宁汤对置带铜宫内节育器家兔锌含量影响的实验研究.湖南中医学院学报,2001;21(3):11-13.
    [30]林芳芬.中西医结合治疗放置宫内节育器后子宫异常出血.中国乡村医药杂志,2002;9(5):15.
    [31]李红霞.中西医结合治疗宫内节育器致阴道淋漓出血的体会.中医药研究,2001;17(6):29.
    [32]尤昭玲,余定国,徐祥英等.葆妇欣对带铜 IUD 副反应的治疗机理研究.中国计划生育学杂志,1999;(2):70-72.
    [33]薛红,周宜,陈刚等.调肝止血中药对放置 Cu-IUD 大鼠外周血清及子宫组织 t-PA,PAI 活性的影响.浙江中医学院学报,2003;27(6):46-48.