少腹逐瘀汤加减联合郑氏“热补针法”治疗子宫腺肌病相关疼痛的临床观察
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摘要
目的:观察少腹逐瘀汤加减联合郑氏"热补针法"治疗子宫腺肌病(AM)相关疼痛(寒凝血瘀证)的疗效及对血管内皮生长因子(VEGF),基质金属蛋白酶-9(MMP-9),基质金属蛋白酶组织抑制剂-1(TIMP-1),前列腺素等因子的影响。方法:将140例符合要求的患者随机分为对照组和观察组各70例。对照组口服去氧孕烯炔雌醇片,1粒/次,1次/d,于月经来潮第1天开始服药,连续服用21 d,停药7 d;并给予郑氏"热补针法",1次/d,每月经周期连续10 d。观察组在对照组治疗的基础上,加用少腹逐瘀汤加减,1剂/d。疗程为3个月经周期。进行治疗前后COX痛经症状评分量表(CMSS),痛经视觉模拟(VAS)评分和慢性盆腔痛评分;进行治疗前后月经量评分(PBAC)和寒凝血瘀证评分;采用B超评价治疗前后子宫体积和子宫内膜厚度;检测治疗前后VEGF,MMP-9,TIMP-1,前列腺素E2(PGE2),前列腺素F2α(PGF2α)和癌抗原125(CA125)水平。结果:观察组临床疗效优于对照组(Z=2. 445,P <0. 05);治疗后观察组患者痛经VAS,COX痛经时间,COX痛经程度和慢性盆腔痛评分均低于对照组(P <0. 01);治疗后观察组患者PBAC评分和寒凝血瘀证评分均低于对照组(P <0. 01),子宫体积和子宫内膜厚度小于对照组(P <0. 01),治疗后观察组患者血清VEGF,MMP-9水平均低于对照组(P <0. 01),TIMP-1水平高于对照组(P <0. 01),MMP-9/TIMP-1低于对照组(P <0. 01);治疗后观察组患者血清PGF2α和CA125水平均低于对照组(P <0. 01),PGE2高于对照组(P <0. 01)。结论:在去氧孕烯炔雌醇片联合郑氏"热补针法"治疗的基础上,采用少腹逐瘀汤加减治疗AM寒凝血瘀证患者,可进一步的减轻疼痛等相关症状,减少月经量,提高临床疗效,其作用机制可能与调节VEGF,MMP-9,TIMP-1和前列腺素等因子表达有关。
Objective: To observe the effect of modified Shaofu Zhuyutang combined with Zheng's Rebuzhen therapy on pain caused by adenomyosis(cold coagulation and blood stasis syndrome) and levels of vascular endothelial growth factor(VEGF),matrix metalloproteinases-9(MMP-9),tissue inhibitors of matrix metalloproteinases(TIMP-1) and prostaglandin. Method: One hundred and twenty-eight patients were randomly divided into control group(63 cases) and observation group(65 cases) by random number table. Patients in control group got desogestrel and ethinylestradiol tablets since the first day of menstruation for consecutive 21 days,1 granule/time,1 time/day,and Zheng's Rebuzhen therapy for consecutive 10 days during the menstruation,1 time/day. In addition to the therapy of control group,patients in observation group were also given Shaofu Zhuyutang,1 dose/day. A course of treatment was 3 menstrual cycles. Before and after treatment,cox menstrual symptom scale(CMSS) of COX,visual simulation of dysmenorrheal(VAS),chronic pelvic pain,pictorial blood loss assessment chart(PBAC) and cold coagulation and blood stasis syndrome were scored. And uterine volume and endometrial thickness were evaluated by B-mode ultrasonography. And levels of VEGF,MMP-9,TIMP-1,prostaglandin E_2(PGE_2), prostaglandin F2α(PGF2α) and cancer antigen were detected. Result: After treatment,the clinical efficacy in observation group was superior to that in control group(Z = 2. 445,P < 0. 05).After treatment,scores of VAS,dysmenorrhea time of COX,dysmenorrheal of COX,chronic pelvic pain,PBAC and cold coagulation and blood stasis syndrome were lower than those in control group(P < 0. 01). And uterine volume and endometrial thickness were lower than those in control group(P < 0. 01). And levels of VEGF,MMP-9,MMP-9/TIMP-1,PGF2αand CA125 were lower than those in control group(P < 0. 01),while levels of TIMP-1 and PGE_2 were higher than those in control group(P < 0. 01). Conclusion: In addition to desogestrel and ethinylestradiol tablets combined with Zheng's Rebuzhen therapy,modified Shaofu Zhuyutang can relieve pain and hemorrhage and improve the clinical efficacy. The mechanism may be correlated with the regulation of expression levels of VEGF,MMP-9,TIMP-1 and prostaglandin.
Objective: To observe the effect of modified Shaofu Zhuyutang combined with Zheng's Rebuzhen therapy on pain caused by adenomyosis(cold coagulation and blood stasis syndrome) and levels of vascular endothelial growth factor(VEGF),matrix metalloproteinases-9(MMP-9),tissue inhibitors of matrix metalloproteinases(TIMP-1) and prostaglandin. Method: One hundred and twenty-eight patients were randomly divided into control group(63 cases) and observation group(65 cases) by random number table. Patients in control group got desogestrel and ethinylestradiol tablets since the first day of menstruation for consecutive 21 days,1 granule/time,1 time/day,and Zheng's Rebuzhen therapy for consecutive 10 days during the menstruation,1 time/day. In addition to the therapy of control group,patients in observation group were also given Shaofu Zhuyutang,1 dose/day. A course of treatment was 3 menstrual cycles. Before and after treatment,cox menstrual symptom scale(CMSS) of COX,visual simulation of dysmenorrheal(VAS),chronic pelvic pain,pictorial blood loss assessment chart(PBAC) and cold coagulation and blood stasis syndrome were scored. And uterine volume and endometrial thickness were evaluated by B-mode ultrasonography. And levels of VEGF,MMP-9,TIMP-1,prostaglandin E_2(PGE_2), prostaglandin F2α(PGF2α) and cancer antigen were detected. Result: After treatment,the clinical efficacy in observation group was superior to that in control group(Z = 2. 445,P < 0. 05).After treatment,scores of VAS,dysmenorrhea time of COX,dysmenorrheal of COX,chronic pelvic pain,PBAC and cold coagulation and blood stasis syndrome were lower than those in control group(P < 0. 01). And uterine volume and endometrial thickness were lower than those in control group(P < 0. 01). And levels of VEGF,MMP-9,MMP-9/TIMP-1,PGF2αand CA125 were lower than those in control group(P < 0. 01),while levels of TIMP-1 and PGE_2 were higher than those in control group(P < 0. 01). Conclusion: In addition to desogestrel and ethinylestradiol tablets combined with Zheng's Rebuzhen therapy,modified Shaofu Zhuyutang can relieve pain and hemorrhage and improve the clinical efficacy. The mechanism may be correlated with the regulation of expression levels of VEGF,MMP-9,TIMP-1 and prostaglandin.
引文
[1]霍智锋,段慧,陈春林,等.子宫动脉栓塞术治疗子宫腺肌病痛经疗效评判时间点的研究[J].中国微创外科杂志,2015,15(5):421-424.
[2]霍智锋,陈春林,刘萍,等.子宫动脉栓塞术治疗子宫腺肌病痛经疗效的相关影响因素及疗效预测模型的构建与验证[J].中华妇产科杂志,2016,51(9):650-656.
[3]李伟华,赵瑞华,张永嘉,等.温阳活血汤加减治疗子宫腺肌病相关疼痛的临床观察[J].中华中医药杂志,2018,33(11):5267-5270.
[4]许琳娜,张绍芬,胡卫国,等.神经生长因子在子宫腺肌病痛经患者血清和病灶内膜中的表达[J].中国实用妇科与产科杂志,2014,30(1):59-63.
[5]蔡仕彬,何佳.子宫腺肌病发病机制及治疗研究进展[J].川北医学院学报,2014,29(3):305-309.
[6]赵玉,郑颖,张斌,等.消异方改善子宫腺肌病患者疼痛症状及胞饮突的研究[J].中医药信息,2018,35(5):69-72.
[7]蒋勇军,桂涛,黄美华,等.子宫腺肌病中医药治疗新进展[J].中国中医基础医学杂志,2016,22(4):585-586.
[8]李广琦,王利军.郑氏“热补针法”治疗阳虚寒凝型原发性痛经60例[J].中医临床研究,2016,8(22):38-39,42.
[9]张小玲,张诗军,徐成康.加味少腹逐瘀汤联合灸法治疗原发性痛经55例[J].中国实验方剂学杂志,2014,20(16):192-195.
[10]冯辉,藏莉,张德重.少腹逐瘀汤加减治疗子宫腺肌病痛经的临床研究[J].南京中医药大学学报,2016,32(2):114-117.
[11]曹泽毅.中华妇产科学[M].3版.北京:人民卫生出版社,2014:1377-1378.
[12]方晓丽,王芬,郑俊江.郑魁山教授创新针法“热补”法与“凉泻”法[J].中国针灸,2012,32(1):35-38.
[13]Cox D J,Meyer R G.Behavioral treatment parameters with primary dysmenorrhea[J].J Behav Med,1978,1(3):297-310.
[14]冯力民,夏恩兰,从捷,等.应用月经失血图评估月经血量[J].中华妇产科杂志,2001,36(1):51.
[15]郎景和.子宫腺肌病的若干问题[J].中国实用妇科与产科杂志,2017,33(2):129-133.
[16]周应芳.子宫腺肌病药物治疗原则及注意事项[J].中国实用妇科与产科杂志,2017,33(2):33-36.
[17]杨舫,赵红.子宫腺肌病的中医研究及进展[J].中日友好医院学报,2018,32(2):8-11.
[18]符泽美,李丽娟,王爱丽.加味少腹逐瘀汤治疗盆腔炎性疾病后遗症-慢性盆腔痛寒湿凝滞证的临床分析[J].中国实验方剂学杂志,2018,24(10):200-205.
[19]艾志刚,管洁.MMP-9及TIMP-1在子宫腺肌病中的表达及临床意义[J].现代妇产科进展,2011,20(5):388-391.
[20]关永格,李坤寅,宋阳.化瘀止痛方对人子宫腺肌病病灶细胞PGF2α,PGE2分泌的影响[J].新中医,2014,46(1):175-177.
[2]霍智锋,陈春林,刘萍,等.子宫动脉栓塞术治疗子宫腺肌病痛经疗效的相关影响因素及疗效预测模型的构建与验证[J].中华妇产科杂志,2016,51(9):650-656.
[3]李伟华,赵瑞华,张永嘉,等.温阳活血汤加减治疗子宫腺肌病相关疼痛的临床观察[J].中华中医药杂志,2018,33(11):5267-5270.
[4]许琳娜,张绍芬,胡卫国,等.神经生长因子在子宫腺肌病痛经患者血清和病灶内膜中的表达[J].中国实用妇科与产科杂志,2014,30(1):59-63.
[5]蔡仕彬,何佳.子宫腺肌病发病机制及治疗研究进展[J].川北医学院学报,2014,29(3):305-309.
[6]赵玉,郑颖,张斌,等.消异方改善子宫腺肌病患者疼痛症状及胞饮突的研究[J].中医药信息,2018,35(5):69-72.
[7]蒋勇军,桂涛,黄美华,等.子宫腺肌病中医药治疗新进展[J].中国中医基础医学杂志,2016,22(4):585-586.
[8]李广琦,王利军.郑氏“热补针法”治疗阳虚寒凝型原发性痛经60例[J].中医临床研究,2016,8(22):38-39,42.
[9]张小玲,张诗军,徐成康.加味少腹逐瘀汤联合灸法治疗原发性痛经55例[J].中国实验方剂学杂志,2014,20(16):192-195.
[10]冯辉,藏莉,张德重.少腹逐瘀汤加减治疗子宫腺肌病痛经的临床研究[J].南京中医药大学学报,2016,32(2):114-117.
[11]曹泽毅.中华妇产科学[M].3版.北京:人民卫生出版社,2014:1377-1378.
[12]方晓丽,王芬,郑俊江.郑魁山教授创新针法“热补”法与“凉泻”法[J].中国针灸,2012,32(1):35-38.
[13]Cox D J,Meyer R G.Behavioral treatment parameters with primary dysmenorrhea[J].J Behav Med,1978,1(3):297-310.
[14]冯力民,夏恩兰,从捷,等.应用月经失血图评估月经血量[J].中华妇产科杂志,2001,36(1):51.
[15]郎景和.子宫腺肌病的若干问题[J].中国实用妇科与产科杂志,2017,33(2):129-133.
[16]周应芳.子宫腺肌病药物治疗原则及注意事项[J].中国实用妇科与产科杂志,2017,33(2):33-36.
[17]杨舫,赵红.子宫腺肌病的中医研究及进展[J].中日友好医院学报,2018,32(2):8-11.
[18]符泽美,李丽娟,王爱丽.加味少腹逐瘀汤治疗盆腔炎性疾病后遗症-慢性盆腔痛寒湿凝滞证的临床分析[J].中国实验方剂学杂志,2018,24(10):200-205.
[19]艾志刚,管洁.MMP-9及TIMP-1在子宫腺肌病中的表达及临床意义[J].现代妇产科进展,2011,20(5):388-391.
[20]关永格,李坤寅,宋阳.化瘀止痛方对人子宫腺肌病病灶细胞PGF2α,PGE2分泌的影响[J].新中医,2014,46(1):175-177.