补肾祛瘀法对中重度宫腔粘连的抗纤维化作用及经血中细胞外基质降解相关因子的影响  

Anti-fibrosis Action of Therapy of Tonifying Kidney and Removing Stasis on Moderate-to-Severe Intrauterine Adhesions and Its Influence on Extracellular Matrix Degradation Related Factors in Menstrual Blood

作　　者：邢娉婷 王爱丽 陈彦辛 XING Ping-Ting;WANG Ai-Li;CHEN Yan-Xin(Haikou Traditional Chinese Medicine Hospital,Hainan 570000 Hainan,China)

机构地区：[1]海口市中医医院,海南海口570000

出　　处：《广州中医药大学学报》2024年第1期96-104,共9页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：海南省自然科学基金高层次人才项目(编号:821RC731)。

摘　　要：【目的】探究补肾祛瘀法对中、重度宫腔粘连的抗纤维化作用及经血中细胞外基质降解相关因子的影响。【方法】将124例肾虚血瘀证中、重度宫腔粘连并拟行宫腔镜宫腔粘连分离术(TCRA)的患者随机分为研究组和对照组,每组各62例。2组患者均给予TCRA治疗,对照组术后给予黄体酮+戊酸雌二醇片治疗,研究组在对照组的基础上联合补肾祛瘀方(以归肾汤加减)治疗,共治疗3个月经周期。观察2组患者治疗前后月经情况、阴道彩色多普勒超声检查指标、肾虚血瘀证评分和宫腔粘连评分的变化情况,检测2组患者治疗前后的血管内皮生长因子(VEGF)、转化生长因子β1(TGF-β1)、血小板源性生长因子(PDGF)、结缔组织生长因子(CTGF)以及基质金属蛋白酶9(MMP-9)m RNA、基质金属蛋白酶抑制因子1(TIMP-1)mRNA、磷脂酰肌醇-3-羟激酶(PI3K)m RNA、Ⅰ型胶原A1蛋白(COL1A1)mRNA的表达水平,并评估2组患者的临床疗效和安全性。【结果】(1)疗效方面:治疗3个月经周期后,研究组患者的总有效率为93.55%(58/62),对照组为80.65%(50/62),组间比较,研究组的疗效明显优于对照组(P<0.05)。(2)月经情况方面,治疗后,2组患者的月经经量、周期、经期均较治疗前明显改善(P<0.05),且研究组患者治疗后的月经经量、周期、经期的恢复情况均明显优于对照组(P<0.05)。(3)阴道彩色多普勒超声检查方面,治疗后,2组患者的子宫血流指数(FI)、搏动指数(PI)、阻力指数(RI)、宫腔容积、子宫内膜厚度等均较治疗前明显改善(P<0.05),其中,研究组患者治疗后的FI、宫腔容积、子宫内膜厚度均明显高于对照组,PI、RI均明显低于对照组(P<0.05或P<0.01)。(4)宫腔粘连评分和肾虚血瘀证评分方面,治疗后,2组患者的宫腔粘连评分和肾虚血瘀证评分均较治疗前明显下降(P<0.05),且研究组患者治疗后的宫腔粘连评分和肾虚血瘀证评分均明显低于对照组(P<0.Objective To investigate the anti-fibrosis action of the therapy of tonifying kidney and removing stasis(shortened to Bushen Quyu method)on moderate-to-severe intrauterine adhesion and its influence on extracellular matrix degradation related factors in menstrual blood.Methods A total of 124 patients with moderate-to-severe intrauterine adhesions of kidney deficiency and blood stasis syndrome who were to undergo transcervical resection of adhesion(TCRA)were randomly divided into a study group and a control group,with 62 patients in each group.Both groups were given TCRA treatment.After the operation,the control group was treated with Progesterone+Estradiol Valerate Tablets,and the study group was treated with the combination of the Bushen Quyu method by using modified Guishen Decoction based on the treatment of the control group.The treatment covered 3 menstrual cycles.The changes in menstrual status,transvaginal color Doppler sonography parameters,scores of kidney deficiency and blood stasis syndrome,and scores of uterine adhesion in the two groups were observed before and after the treatment.Moreover,the two groups were observed before and after treatment in the changes of vascular endothelial growth factor(VEGF),transforming growth factorβ1(TGF-β1),platelet-derived growth factor(PDGF),and connective tissue growth factor(CTGF)as well as the mRNA expression levels of matrix metalloproteinase 9(MMP-9),matrix metalloproteinase inhibitory factor 1(TIMP-1),phosphatidylinositol-3-hydroxykinase(PI3K)and collagen type I A1 protein(COL1A1).After treatment,the clinical efficacy and safety of the two groups were assessed.Results(1)After 3 menstrual cycles of treatment,the total effective rate in the study group was 93.55%(58/62),and that in the control group was 80.65%(50/62).The intergroup comparison showed that the therapeutic effect of the study group was significantly superior to that of the control group(P<0.05).(2)After treatment,the menstrual flow,menstrual cycle and menstrual period of the two groups were signif

关 键 词：补肾祛瘀法 归肾汤 宫腔粘连 肾虚血瘀 纤维化因子 细胞外基质 子宫内膜 

分 类 号：R271.9[医药卫生—中西医结合]