化湿解毒汤对高级别CIN高危型HPV感染者LEEP术后湿热下注证患者转归的影响  

Effect of Huashi Jiedu Decoction on Disease Outcome of Patients Infected with High-grade CIN and High-risk HPV with Shire Xiazhu Symptom After LEEP Operation

作　　者：孙桂霞[1] 李艳云[1] 杨少琴[1] 

机构地区：[1]河南大学淮河医院,河南开封475000

出　　处：《中国实验方剂学杂志》2017年第16期182-187,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河南省高等学校重点科研计划项目(17A320023)

摘　　要：目的:探讨化湿解毒汤对高级别CIN高危型HPV感染者LEEP术后湿热下注证患者的临床疗效,并从凋亡抑制基因即生存素(Survivin)和增殖细胞核抗原(Ki67)表达及HPV病毒载量等方面探讨了其对转归的影响。方法:将160例CIN高危型HPV感染者,采用SAS软件生成,随机按1∶1比例分为观察组和对照组。两组患者均给予LEEP术治疗。术后对照组给予重组人干扰素α-2 b凝胶宫颈外涂,连续10 d为1个疗程,共使用3个月经周期。观察组在对照组治疗的基础上加用化湿解毒汤内服,1剂/d。连续服用3个月经周期,再行3个月经周期随访。检测术前和术后6个月患者Survivin,Ki67水平阳性表达情况和人乳头瘤病毒(HPV)DNA基因(HPV-DNA)病毒载量;进行术前和术后3个月慢性宫颈炎和湿热下注证的评价;检测术前和术后3个月宫颈局部灌洗液γ-干扰素(IFN-γ),白细胞介素-10(IL-10),白细胞介素-12(IL-12),白细胞介素-2(IL-2)和白细胞介素-4(IL-4)水平。结果:观察组临床疗效总有效率为94.52%,对照组为81.69%,观察组高于对照组(χ~2=6.691,P<0.05);治疗后观察组中医证候疗效总有效率为95.89%,对照组为78.87%,观察组高于对照组(χ~2=9.529,P<0.01);术后6个月,观察组高危型人乳头瘤病毒(hr-HPV)阴转率为91.78%,对照组为77.46%,观察组高于对照组(χ~2=5.699,P<0.05);观察组患者在术后6个月hr-HPV病毒载量低于对照组(P<0.01);术后6个月,观察组Survivin和Ki67阳性表达情况弱于对照组(P<0.05),观察组Survivin阴转率为73.97%,高于对照组的56.34%(χ~2=4.938,P<0.05),观察组Ki67阴转率为80.82%,高于对照组的59.15%(χ~2=8.067,P<0.01);术后3个月观察组IFN-γ,IL-2和IL-12水平均高于对照组,IL-4和IL-10水平均低于对照组(P<0.01)。结论:采用化湿解毒汤干预CIN高危型HPV感染LEEP术后患者,能提高患者的临床治疗效果,能促使hr-HPV阴转,降低病毒载量,能降低Survivin和Ki67阳性表达,并调节Th1/Th2平衡,从而�Objective：To discuss the clinical efficacy of Huashi Jiedu decoction on patients infected with high-grade cervical intraepithelial neoplasia（CIN） and high-risk human papillomavirus（HPV） Shire Xiazhu symptom after loop electrosurgical excision procedure（LEEP） operation,and the effect on disease outcome according to the expressions of apoptosis inhibition gene surviving and proliferating cell nuclear antigen Ki67 and the HPV viral load.Method：One hundred and sixty patients with high-grade cervical intraepithelial neoplasia CIN and high-risk HPV were randomly divided into control group（80 cases） and observation group（80 cases）according to random tables generated by SAS software.The two group＇s patients got LEEP operation.After operation,patients in control group were given LEEP operation recombinant human interferon α-2 b gel outside of cervix.A course of treatment was 10 days,and the treatment shall last for 3 continued menstrual cycles.In addition to the therapy of control group,patients in observation group were also given Huashi Jiedu decoction,1 dose/day for 3 continued menstrual cycles.And follow-up visit continued for 3 menstrual cycles.Before the operation and at the 6thmonth after the operation,positive expressions of Survivin,Ki67 and human papilloma virus（HPV） DNA gene（HPV-DNA） virus were detected.At the 3thmonth before and after the operation,chronic cervicitis and Shirexiazhu symptom were evaluated,and levels of γ-interferon（IFN-γ）,and levels of interleukin-2,4,10,12（IL-2,4,10,12） were detected.Result：The total clinical rate in observation group was 94.52%,which was higher than 81.69% in control group（χ2= 6.691,P〈0.05）.The total rate of traditional Chinese medicine（TCM） syndrome in observation group was 95.89%,which was higher than 78.87% in control group（χ2= 9.529,P〈0.01）.Six months later after the operation,negative rate of human papilloma virus（HPV） was91.78%,which was higher than 77.76% in control group（χ2= 5.699,P〈0.05）.The

关 键 词：宫颈上皮内瘤变 人类乳头状瘤病毒 高危型 化湿解毒汤 基因即生存素 增殖细胞核抗原 病毒载量 

分 类 号：R287[医药卫生—中药学]