仙旱合剂治疗排卵障碍性异常子宫出血疗效及机制探讨  

Curative effect and mechanism of Xianhan Mixture in treatment of abnormal uterine bleeding‐ovulatory dysfunction

作　　者：刘恒炼[1] 冯倩[1] 夏敏[1] LIU Heng-lian;FENG Qian;XIA Min(Department of Gynecology,Chongqing Hospital of Traditional Chinese Medicine,Chongqing 400021,China)

机构地区：[1]重庆市中医院妇科,重庆400021

出　　处：《中草药》2023年第12期3921-3931,共11页Chinese Traditional and Herbal Drugs

基　　金：重庆市卫生计生委中医药科技项目(ZY201602106);重庆市中医药重点学科项目[(2018)43];国家中医药管理局第三届国医大师传承工作室及全国名中医传承工作室(2018YFC1704104);第七批全国老中医药专家学术经验传承项目[(2022)79];夏敏重庆英才·创新领军人才项目[2019(2)]。

摘　　要：目的通过网络药理学分析仙旱合剂治疗排卵障碍性异常子宫出血(abnormal uterine bleeding-ovulatory dysfunction,AUB-O)的作用机制,观察仙旱合剂治疗AUB-O的临床疗效,以及从血液动力学、血清白细胞介素-17(interleukin-17,IL-17)信号通路相关因子水平的变化对其作用机制进行探讨。方法通过网络药理学分析仙旱合剂治疗AUB-O的活性成分及作用机制。选择重庆市中医院妇科97例血热型AUB-O患者,运用随机数字表法分为对照组49例和治疗组48例。对照组患者口服宫血宁胶囊治疗,治疗组患者口服仙旱合剂治疗,治疗持续10 d。观察两组的临床疗效,比较两组治疗前后的出血量、止血时间、D-二聚体水平、血小板数量、子宫血液动力学、优势卵泡率以及血清血栓素A_(2)(thromboxane A_(2),TXA_(2))、前列环素I2(prostaglandin I2,PGI2)、前列腺素E_(2)(prostaglandin E_(2),PGE_(2))、前列腺素F2α(prostaglandin F2α,PGF2α)水平及IL-17信号通路相关因子IL-6、IL-1β、基质金属蛋白酶(matrix metalloproteinase 9,MMP9)、MMP1、转录激活蛋白-1(activator protein-1,AP-1)、环氧合酶-2(cyclooxygenase-2,COX-2)、核因子-κB(nuclear factor-κB,NF-κB)的变化情况。结果通过网络药理学发现仙旱合剂治疗AUB-O与IL-17信号通路相关。治疗组总有效率为95.8%,对照组总有效率为79.6%,两组比较差异有统计学意义(P<0.05)。治疗后,两组出血量随着治疗时间的延长均减少,第7、10天出血量比治疗前及第3天显著减少(P<0.05),第10天出血量显著少于第7天(P<0.05),第10天出血量治疗组显著少于对照组(P<0.05);治疗组止血时间显著短于对照组(P<0.05)。治疗后,与治疗前比较,治疗组患者子宫动脉子宫动脉收缩期最大血流速度/舒张末期血流速度(S/D)、阻力指数(RI)升高,D-二聚体下降(P<0.05),对照组改善不明显,且治疗组S/D显著高于对照组(P<0.05)。治疗后,两组血小板数量与治疗前比较显著增Objective To observe the clinical efficacy of Xianhan Mixture(仙旱合剂)in the treatment of abnormal uterine bleeding‐ovulatory dysfunction(AUB-O),analyze its active ingredients and signal pathway through network pharmacology,and explore the mechanism in hemodynamics and interleukin-17(IL-17)signal pathway.Method The active ingredients and mechanism of Xianhan Mixture in the treatment of AUB-O were analyzed by network pharmacology.A total of 97 cases of hemothermic AUB-O were selected from the department of gynecology in Chongqing Hospital of Traditional Chinese Medicine.They were randomly divided into control group(49 cases)and treatment group(48 cases).The control group was given Gongxuening Capsule(宫血宁胶囊)orally,and the treatment group was given Xianhan Mixture orally for 10 d.The clinical effect of the two groups was observed.The bleeding volume,bleeding time,D-dimer level,platelet count,uterine hemodynamics,dominant follicle rate and serum thromboxane A_(2)(TXA_(2))and prostaglandin I2(PGI2),prostaglandin E_(2)(PGE_(2)),prostaglandin F2α(PGF2α)level and IL-17 signaling pathway related factors IL-6,IL-1β,matrix metalloproteinase 9(MMP9),MMP1,activator protein-1(MMP1),activator protein-1(AP-1),cyclooxygenase-2(COX-2),and nuclear factor-κB(NF-κB)were compared between the two groups before and after treatment.Results Through network pharmacological analysis,it was found that the treatment of AUB-O by Xianhan Mixture was related to IL-17 signaling pathway.The total effective rate was 95.8%in the treatment group and 79.6%in the control group,the treatment group was superior to the control group(P<0.05).After treatment,the bleeding volume in the two groups decreased with the extension of treatment time,the bleeding volume in the 7th and 10th day was significantly reduced compared with that before treatment and the 3rd day(P<0.05),the bleeding volume in the 10th day was significantly less than that in the 7th day(P<0.05),and bleeding volume in the 10th day was significantly less than that in the c

关 键 词：排卵障碍性异常子宫出血 仙旱合剂 网络药理学 IL-17信号通路 止血作用 

分 类 号：R285.64[医药卫生—中药学]