中药联合输卵管造影术治疗输卵管性不孕的临床疗效
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摘要
目的观察中药多途径联合X线输卵管造影术治疗输卵管性不孕患者临床疗效及对血清IL-6、ICAM-1影响。方法纳入输卵管性不孕患者184例,采用随机数字表法分为治疗组和对照组各92例。治疗组给予中药多途径辅助治疗+X线输卵管造影术;对照组给予穴位注射+X线输卵管造影术,连续治疗3个月。观察两组妊娠情况、输卵管通畅度和临床疗效,检测血清IL-6、ICAM-1含量。结果治疗后,治疗组宫内妊娠率为56.0%(51/92),对照组妊娠率为39.8%(36/92),两组比较差异有统计学意义(χ2=4.955,P=0.037);治疗后治疗组通畅度为56.0%(51/92),对照组通畅度为39.8%(36/92%),两组比较差异有统计学意义(Z=-2.847,P=0.035);两组血清IL-6、ICAM-1含量评分均较治疗前降低(P<0.05);治疗后治疗组IL-6 (pg/ml)、ICAM-1(μg/L)[(51.05±8.81) pg/ml比(70.24±9.15),t=5.030]、[(165.37±40.28)μg/L比(204.81±36.52)μg/L,t=6.405]均低于对照组(P<0.05);治疗组总有效率为95.65%(88/92),对照组为89.13%(82/92),两组比较差异有统计学意义(Z=-2.783,P=0.005)。结论中药多途径联合X线输卵管造影术治疗输卵管性不孕疗效满意,改善输卵管通畅性、降低血清IL-6、ICAM-1含量,提高妊娠率。
Objective To observe the clinical effect on tubal factor infertility(TFI) in the patients after treated with multi-approach of Chinese herbal medicine and X-ray salpingography and the impact on serum IL-6 and ICAM-1.Methods A total of 184 patients with TFI were divided into a treatment group and a control group,92 cases in each one according to random number table.The contraception with condom was used during treatment in the two groups.In the treatment the combined treatment with multi-approach of Chinese herbal medicine and X-ray salpingography was adopted.In the control group,the acupoint injection and X-ray salpingography were combined.The treatment lasted for 3 months.The pregnancy condition,tubal unobstruction and clinical effect were observed in the two groups.The levels of IL-6 and ICAM-1 in serum were determined.Results The uterine pregnancy rate was 56.0%(51/92) in the treatment group and was 39.8%(36/92) in the control group,indicating the significant difference(χ2= 4.955,P = 0.037).The unobstructed rate was 56.0%(51/92) in the treatment group and was 39.8%(36/92) in the control group,indicating the significant difference(Z =-2.847,P = 0.035).After treatment,the levels of IL-6 and ICAM-1 were reduced as compared with those before treatment in the two groups(P<0.05).After treatment,the results of IL-6(pg/ml) and ICAM-1(μg/L) in the treatment groups were lower than the control group[(51.05 ± 8.81) pg/ml vs(70.24 ± 9.15),t = 5.030;165.37± 40.28) μg/L vs(204.81 ± 36.52) μg/L,t = 6.405](P<0.05).The total effective rate was 95.65%(88/92) in the treatment group and was 89.13%(82/92) in the control group,indicating the significant difference(Z =-2.783,P =0.005).Conclusion The combined treatment with multi-approach of Chinese herbal medicine and X-ray salpingography achieves the satisfactory effect on TFI.This combined therapy removes the tubal obstruction,reduces the levels of serum IL-6 and ICAM-1 and improves the pregnancy rate.
Objective To observe the clinical effect on tubal factor infertility(TFI) in the patients after treated with multi-approach of Chinese herbal medicine and X-ray salpingography and the impact on serum IL-6 and ICAM-1.Methods A total of 184 patients with TFI were divided into a treatment group and a control group,92 cases in each one according to random number table.The contraception with condom was used during treatment in the two groups.In the treatment the combined treatment with multi-approach of Chinese herbal medicine and X-ray salpingography was adopted.In the control group,the acupoint injection and X-ray salpingography were combined.The treatment lasted for 3 months.The pregnancy condition,tubal unobstruction and clinical effect were observed in the two groups.The levels of IL-6 and ICAM-1 in serum were determined.Results The uterine pregnancy rate was 56.0%(51/92) in the treatment group and was 39.8%(36/92) in the control group,indicating the significant difference(χ2= 4.955,P = 0.037).The unobstructed rate was 56.0%(51/92) in the treatment group and was 39.8%(36/92) in the control group,indicating the significant difference(Z =-2.847,P = 0.035).After treatment,the levels of IL-6 and ICAM-1 were reduced as compared with those before treatment in the two groups(P<0.05).After treatment,the results of IL-6(pg/ml) and ICAM-1(μg/L) in the treatment groups were lower than the control group[(51.05 ± 8.81) pg/ml vs(70.24 ± 9.15),t = 5.030;165.37± 40.28) μg/L vs(204.81 ± 36.52) μg/L,t = 6.405](P<0.05).The total effective rate was 95.65%(88/92) in the treatment group and was 89.13%(82/92) in the control group,indicating the significant difference(Z =-2.783,P =0.005).Conclusion The combined treatment with multi-approach of Chinese herbal medicine and X-ray salpingography achieves the satisfactory effect on TFI.This combined therapy removes the tubal obstruction,reduces the levels of serum IL-6 and ICAM-1 and improves the pregnancy rate.
引文
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[3]李玉华,陈颖,韩立薇,等.生殖道炎性因子及病原体的表达及其与输卵管性不孕的相关性[J].广东医学,2016,37(2):247-249.
[4]沈桂红.子宫输卵管造影与宫腹腔镜在诊断输卵管不孕中的对照分析[J].中国妇幼保健,2013,28(33):5542-5543.
[5]李俊箐,李祥云.输卵管性不孕的诊疗研究进展[J].中华中医药学刊,2015,33(11):2661-2665.
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[8]中华医学会.临床诊疗指南-妇产科分册[M].北京:人民卫生出版社,2007:167-169.
[9]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:268.
[10]EI Fekih C,Onerdiane N,Mourali M,et al. Selective salpingography and tubal catheterization in infertile women[J]. Tunis Med,2012,90(3):233-237.
[11]羊冬梅,李宁宁,牛国昌,等. X线透视下子宫输卵管造影术在女性不孕症患者中诊断和治疗中的应用价值研究[J].中国性科学,2017,26(5):121-124.
[12]郑兴邦,关菁,田莉,等.子宫输卵管造影实时动态的临床观察[J].中国计划生育学杂志,2011,19(1):30-33.
[13]李晓宇,李晓骄阳,孙蓉.柴胡皂苷d对人肝细胞L-02“量-时-毒”关系及机制研究[J].中药药理与临床,2016,32(2):87-90.
[14]朱尧,刘溦溦,顾宁,等.川芎的活性成分及其心血管系统保护作用研究进展[J].时珍国医国药,2016,27(7):1701-1704.
[15]马霞,丁军霞,顾志荣,等.当归挥发油对人脐静脉内皮细胞增殖作用的谱效关系[J].中国实验方剂学杂志,2017,23(6):70-73.
[16]陆小华,马骁,王建,等.赤芍的化学成分和药理作用研究进展[J].中草药,2015,46(4):595-602.
[17]张健萍,李连珍,赵红江,等.牡丹皮的化学成分、药理作用及临床应用研究概况[J].中华中医药杂志,2006,21(5):295-297.
[18]谢沈阳,杨晓源,丁章贵,等.蒲公英的化学成份及其药理作用[J].天然产物研究与开发,2012,24(S1):141-151.
[19]刘恒炼,翁双燕,张园,等.中药多途径辅助治疗对输卵管炎性不孕患者的疗效及血清炎症因子的影响[J].中国中西医结合杂志,2016,36(9):1034-1037.
[20]Naidenow J,Hrgovic I,Doll M,et al. Peroxisome proliferator-activated receptor(PPAR)αandδactivators induce ICAM-1 expression in quiescent non stimulated endothelial cells[J]. Journal of inflammation,2016,1(3):27.
[21]Kwack MH,Ahn JS,Kim MK,et al. Dihydrotestosterone-Inducible IL-6 Inhibits Elongation of Human Hair Shafts by Suppressing Matrix Cell Proliferation and Promotes Regression of Hair Follicles in Mice[J]. The Journal of Investigative Dermatology,2011,132(1):43-49.
[2]Schmidt L. Infertility and assisted reproduction in Denmark. Epidemiology and psychosocial consequences[J]. Danish Medical Bulletin,2006,53(4):390-417.
[3]李玉华,陈颖,韩立薇,等.生殖道炎性因子及病原体的表达及其与输卵管性不孕的相关性[J].广东医学,2016,37(2):247-249.
[4]沈桂红.子宫输卵管造影与宫腹腔镜在诊断输卵管不孕中的对照分析[J].中国妇幼保健,2013,28(33):5542-5543.
[5]李俊箐,李祥云.输卵管性不孕的诊疗研究进展[J].中华中医药学刊,2015,33(11):2661-2665.
[6]Santulli P,Lamau MC,Marcellin L,et al. Endometriosis-related infertility:ovarian endometrioma per se is not associated with presentation for infertility[J]. Human reproduction(Oxford,England),2016,31(8):1765-1775.
[7]乐杰.妇产科学[M]. 7版.北京:人民卫生出版社,2008:115.
[8]中华医学会.临床诊疗指南-妇产科分册[M].北京:人民卫生出版社,2007:167-169.
[9]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:268.
[10]EI Fekih C,Onerdiane N,Mourali M,et al. Selective salpingography and tubal catheterization in infertile women[J]. Tunis Med,2012,90(3):233-237.
[11]羊冬梅,李宁宁,牛国昌,等. X线透视下子宫输卵管造影术在女性不孕症患者中诊断和治疗中的应用价值研究[J].中国性科学,2017,26(5):121-124.
[12]郑兴邦,关菁,田莉,等.子宫输卵管造影实时动态的临床观察[J].中国计划生育学杂志,2011,19(1):30-33.
[13]李晓宇,李晓骄阳,孙蓉.柴胡皂苷d对人肝细胞L-02“量-时-毒”关系及机制研究[J].中药药理与临床,2016,32(2):87-90.
[14]朱尧,刘溦溦,顾宁,等.川芎的活性成分及其心血管系统保护作用研究进展[J].时珍国医国药,2016,27(7):1701-1704.
[15]马霞,丁军霞,顾志荣,等.当归挥发油对人脐静脉内皮细胞增殖作用的谱效关系[J].中国实验方剂学杂志,2017,23(6):70-73.
[16]陆小华,马骁,王建,等.赤芍的化学成分和药理作用研究进展[J].中草药,2015,46(4):595-602.
[17]张健萍,李连珍,赵红江,等.牡丹皮的化学成分、药理作用及临床应用研究概况[J].中华中医药杂志,2006,21(5):295-297.
[18]谢沈阳,杨晓源,丁章贵,等.蒲公英的化学成份及其药理作用[J].天然产物研究与开发,2012,24(S1):141-151.
[19]刘恒炼,翁双燕,张园,等.中药多途径辅助治疗对输卵管炎性不孕患者的疗效及血清炎症因子的影响[J].中国中西医结合杂志,2016,36(9):1034-1037.
[20]Naidenow J,Hrgovic I,Doll M,et al. Peroxisome proliferator-activated receptor(PPAR)αandδactivators induce ICAM-1 expression in quiescent non stimulated endothelial cells[J]. Journal of inflammation,2016,1(3):27.
[21]Kwack MH,Ahn JS,Kim MK,et al. Dihydrotestosterone-Inducible IL-6 Inhibits Elongation of Human Hair Shafts by Suppressing Matrix Cell Proliferation and Promotes Regression of Hair Follicles in Mice[J]. The Journal of Investigative Dermatology,2011,132(1):43-49.