摘要
目的 建立SD大鼠子宫内膜异位症模型，探讨隔药饼灸治疗子宫内膜异位症的可能作用机理。
方法 SD大鼠随机分为正常组和造模组，将造模组大鼠自体子宫内膜移植，建立子宫内膜异位症模型。造模结束后，随机分为模型组、隔药饼灸组、温和灸组、达那唑组，进行对比治疗。实验结束，用放免法测定各组大鼠血清IL-6和血浆PGE_2水平，并对异位子宫内膜病灶进行外观观察及病理组织学检查。
结果 ①模型组大鼠血清IL-6和血浆PGE_2水平比正常组明显升高，差异均有非常显著性意义(P＜0.01，P＜0.005)；②隔药饼灸、达那唑和温和灸三个治疗组与模型组相比，血清IL-6水平分别有不同程度的降低，差异均有显著性意义(P＜0.01，P＜0.01和P＜0.05)，三个治疗组之间相比，差异无显著性意义(P＞0.05)；③三个治疗组的血浆PGE_2水平与模型组比较，分别有不同程度的降低，差异均有非常显著性意义(P＜0.005，P＜0.005和P＜0.01)；隔药饼灸与达那唑组间差异无显著性意义(P＞0.05)；但此二组与温和灸组相比，差异均有显著性意义(P＜0.05，P＜0.05)。④外观观察：三个治疗组异位内膜病灶体积，与模型组相比均有不同程度的缩小(P＜0.005，P＜0.01和P＜0.05)，隔药饼灸与温和灸组间差异有显著
性意义(尸<0.05);囊肿结节萎缩或消失，表面血管明显减少等外
观恢复率，隔药饼灸和达那哇两组与模型组比较，差异均有显著性
意义(尸<0.01和p<0.05);提示三种疗法均可明显改善异位病灶，
以隔药饼灸和达那哇最为显著。⑤病理组织学检查显示:三个治疗
组的子宫内膜腺体数目减少，腺体萎缩，间质细胞小而稀疏，有陈
}日性出血点。
结论隔药饼灸可能通过降低血清IL一6和血浆PGE:水平，调节
机体的免疫功能，抑制异位内膜的增生生长，促其萎缩等机制治疗
子宫内膜异位症，其疗效与达那哇相仿，优于温和灸。此法不失为
临床治疗子宫内膜异位症的有效途径之一。
Objective To establish the experimental endometriosis in rats, to study the ectopic endometrum's histological structure change and to explore the mechanism of the effect of moxibustion separated by herbal cake on the treatment of endometriosis.
Methods 60 SD rats were randomly divided into two groups: the normal and the experimental. 51 SD rats were induced by surgery for the experimental endometriosis. After the model be made, rats in the experimental group were divided into endomrtriosis model group(EMM), moxibustion separated by herbal cake group(MSBHC), mild moxibustion group (MM), and Danazol group to treat for thirty days respectively. Then, the levels of Interleukin-6(IL-6) in the blood serum and prostaglandinE2 (PGE2) in the blood plasma of all groups were measured by radioimmunoassay(RIA); the ectopic endometrium's focuses were observed by microscope and eyes.
Results (1)Compared with the normal group, the levels of IL-6 in the blood serum and PGE2 in the blood plasma of EMM group were significantly higher (P<0.01 and P<0.005 respectively). (2)After treatment, the levels of IL-6 in the blood serum in the three treated groups were degraded significantly as compared with those of EMM group (P<0.01, P<0.01 and P<0.05 respectively), but without statistical meaning for the changes of IL-6 levels between these groups (P>0.05); (3)The levels of PGE2 in the blood plasma of three treated groups became obviously lower than those of EMM group, which showed very significance (P<0.005, P<0.005 and P<0.01 respectively); there was no difference between MSBHC group and Danazol group (P>0.05), but these two groups had difference
from MM group(P<0.05, P<0.05 respectively ). (4)As eyes observing, the volume of ectopic endometrium in rats of three treated groups shrinked comparing with those of the EMM geoup; and there were significance between the MSBHC group and the MM group( P<0.01). The ectopic endometrium's cysts or nodes shrinked or dissolved, the surface blood vessels reduced, so these showed that the three methods all could significantly improve the ectopic endometrium's focuses (P<0.05) in observation for appearance, especially markedly in the MSBHC group and the Danazol group(.P<0.01, P<0.05 respectively ), but no difference between the two groups. (5)There were less counts shrinked glands, small glandular cavity and stromal cells and obsoleted blood dot by microscope observation in three treated groups.
Conclusion It is suggested that the therapy of moxibustion separated by herbal cake similar Danazol might regulate the immune disturbance in endometriosis and inhibit the ectopic endomrtrium's hyperplastic and develop, promoted their shrink atrophy by decreasing the levels of IL-6 in the blood serum and PGE2 in the blood plasma to treat endometriosis; so it's one of effective methods in clinical practice for treantment on endometriosis and superior to the mild moxibustion method.
引文
1 Vernon MW, Wilson EM. Studies on the surgical incluction of endometriosis in the rat [J]. Fertil Steril, 1985,44:684～694.
2 肖纯，黄桂林，彭泽华，等．大鼠实验性子宫内膜异位症模型制．中国病理生理杂志．1995，11(3)：332～333．
3 林文注，王佩．实验针灸学．上海：上海科技出版社，1998．288～290．
4 Vernon MW, Wilson EM. Studies on the surgical incluction of endometriosis in the rat [J]. Fertil Steril,1985,44:684～694.
5 肖纯，黄桂林，彭泽华，等．大鼠实验性子宫内膜异位症模型复制．中国病理生理杂志，1995，11(3)：332～333．
6 中国中西医结合学会妇产科专业委员会第三届学术会议修订·内膜异位症、妊娠高血压综合征及女性不孕的中西医结合诊疗标准．中西医结合杂志，1991，11(6)：376．
7 刘海洋．中西医对子宫内膜异位症病因病机研究新进展．广西中医学院学报，2000，17(2)：62～63．
8 李大金，李超荆，朱影，等．滋阴降火中药治疗免疫性不孕症．中国中西医结合杂志，1995，15(1)：3～5．
9 汪慧敏．穴位注射加隔药饼灸治疗子宫内膜异位症临床研究．中国针灸，2000，11：647～648．
10 陈太羲，郝道猛，罗富刚．分次辐射与艾灸对耀患皮下肿痛小白鼠的影响．中国医药学院研究年报，1988，(14)：79．
11 谢莉莉，刘光谱．艾灸的治疗作用和机理研究进展．针灸临床杂志，2000，16(5)：55～57．
12 李大金．生殖免疫学讲义，1992，11．
13 薛文隽，吴国忠．活血化瘀中药抗衰老作用的现代药理研究进展[J]．中医药研究，1998，15(2)：53～55．
14 黄崇巧．活血化瘀法治疗子宫内膜异位症概述．中医药信息，1993．3：13．
15 刘健，李祥云，胡晓梅．补肾祛瘀法治疗子宫内膜异位症的临床观察．中国中西医结合杂志，1998，18(3)：145～147．
16 李淑萍，白淑芳，孙家强．活血化瘀软坚散结法对子宫内膜异位症模型大鼠免疫功能的影响．武警医学院学报，2000,9(4)：260～262．
17 陈雄华，刘又香．针灸“足三里”“关元”穴对阳虚大鼠免疫功能影响的比较研究．中国针灸，2000,9：555～557．
18 纪巍，宋晖．子宫内膜异位症的发病机制研究．国外医学妇幼保健分册，2000，11(4)：145～147．
19 肖丽娟，石建军，杨增明．子宫内膜异位症患者子宫内膜和腹腔液成分变化的研究进展．中华妇产科杂志，2001，36(6)：379～280．
20 kitawaki J, Noguchi T. Expression of aromatase cytochrome P450 Protein and messnger ribonucleic acid in human endometriotic and endometriotic tissnes tissues but in normal endometrium. Biol Reprod, 1997,57:514～519.
21 Jacobs AL. Secretion and hormonal regulation of IL-6 production by mouse uterine stromal and polarized epithelial cells cultured in vitro. Endocriology, 1992,131:1037～1046.
22 keenan JA. Immunodulation of rat endometriotic implant growth and protein production. Am J Reprod Immunol,1994,32(3): 180～183.
23 Akoum A, Lemay A, paradis I, et al. Secretion of interleukin-6 by human endometriotic cells and regulation by proinflammatory cytokines and sex steroids. Hum Reprod, 1996,11(10):2269～2275.
24 Drier SE. Dysregulation of IL-6 responses in ectopic endometrial stromal cells. J Cline Endocrinol Metab 1995,80:1431～1434.
25 Dmonski WP. Immunological aspects of endometriosis. Int J Gynecol, 1995,50(suppl): 53.
26 Witz CA. Interleukin-6: another piece of the endometriosis-cytokine puzzle. Fertil Steril, 2000,73:212～214.
27 Noble LS, Simpson ER, Johns A, et al. Aromatase expression in endometriosis. J Clin Endocrinol Metab, 1996;81 (1): 174～179.
28 Calogero AE. Macrophage-derived cytokines in the follicular fluid of women with infertility due to immunological cause. Cytokine 1998,10:814.
29 郑斐，吕时铭．白介素-6 调节颗粒细胞雌孕激素分泌的作用．生殖和避孕，2001，21(2)：81～84．
30 周龙书，肖箐．子宫内膜异位症患者腹腔液中 NK 细胞活性及细胞因子测定．广东医学，2001，22(3)：211～212．
31 Rana N, Braum DP, House R, et al. Basal and Stimulated Scretion of Steril[J] Fertil Steril. 1996.65(4):925～930.
32 Morita M. Prostaglandins in peritoneal fluid of women with minimal and mild endometriosis. Nippon Sanka Fujinuka Gakkai Zasshi. 1991,43(7):741.
33 王晓农．前列腺素与变态反应．国外医学免疫分册，1990,(6)：297．
34 张人捷，韩美玲．子宫内膜异位症的在位内膜和异位内膜结节前列腺
素测定．中华妇产科杂志，1984，19(2)：93．
35 Brancroft K. Minimal/mild endometriosis and infertility. A review Br J Obstet Gynecol, 1989,96:454.
36 Kuo TM. Influence of peritoneal fluid with endometriosis on the develop of mouse embryos. Nippon Sanka Fujinka Gakkai Zasshi. 1990 Oct, 42(10):1284～90.
37 Bulun SE, Zeitoun K. Estrogen production in endometriosis and use of aromatase inhibitors to treat endometriosi. Endocr Relat Cancer 1999 Jun, 6(2):293～301.
38 Noble LS, Takayama K, Zeitoum KM, et al. ProtaglandinE2 stimulates aromatase expression in endometriosis-drived stromal cell. J Clin Endocrinol Metab, 1997,82(2):600～606.
39 Garzett GG, Ciavattini A. Decrease in peripheral blood polymorphonuclear leukocyte chemotactic index in endometriosis: role of prostaglandinE2 release. Obstet Gynecol 1998, Jan,91 (1):25～9.
40 Kozawa O, Suzuki A, Tokuda H, et al. Interleukin-6 synthesis by protaglandinE2: cross-lack reculation by proteikinase. Bone, 1998 Apr;22(4): 355～360.
41 Ma TC, Zhu XZ. Suppression of lipopoly saccharide-induced impairment of active avoidance and interleukin-6-induced increase of PGE2 release in rats by indometacin. Areneimittel forschung. 1997 May,47(5):595～597.