补肾化瘀方加减对肾虚血瘀型子宫内膜异位症术后复发的预防作用与机制研究

Preventive effect and mechanism of Bushen Huayu Formula on postoperative recurrence of endometriosis with kidney deficiency and blood stasis

关键词:  补肾化瘀方加减  子宫内膜异位症术后  炎症  抗子宫内膜抗体  复发率

Key words:  Bushen Huayu Formula plus or minus  postoperative endometriosis  inflammation  anti-endometrial antibody  recurrence rate

摘要:

[目的] 探讨补肾化瘀方加减对肾虚血瘀型子宫内膜异位症术后复发的预防作用与机制。[方法] 选择于2019年1月—2021年1月在衡水市第四人民医院治疗的子宫内膜异位症患者320例，按随机数字表法随机分组，常规西医组160例，给予患者常规西医治疗，补肾化瘀方组160例，在常规西医治疗同时给予患者补肾化瘀方加减治疗，治疗前后检测两组患者血清性激素[促黄体生成素（LH）、孕激素（P）、雌激素（E₂）]，肿瘤坏死因子-α（TNF-α），血管内皮生长因子（VEGF），抗子宫内膜抗体（EMAb）水平，通过语言描述评分法（VRS）评价患者痛经及非经期盆腔痛情况，给予患者中医证候评分，比较两组临床疗效，记录两组患者2年复发率及治疗期间两组患者不良反应发生情况。[结果] 补肾化瘀方组患者痛经及非经期盆腔痛评分低于常规西医组（P＜0.05），补肾化瘀方组TNF-α、VEGF、EMAb水平较常规西医组低（P＜0.05），补肾化瘀方组患者LH、P、E₂含量较常规西医组明显低（P＜0.05），补肾化瘀方组患者中医证候评分较常规西医组明显降低（P＜0.05），补肾化瘀方组患者总有效率（97.50%）较常规西医组（88.13%）高（P＜0.05），常规西医组2年复发率为12.90%，补肾化瘀方组2年复发率为3.21%，两组2年复发率比较，差异有统计学意义（P＜0.05），补肾化瘀方组开始复发时间长于常规西医组（P＜0.05）；治疗期间两组患者均无明显不良反应发生。[结论] 补肾化瘀方加减治疗肾虚血瘀型子宫内膜异位症术后疗效显著，可有效缓解患者痛经及非经期盆腔痛，降低复发率，其作用机制可能与其抑制机体炎症，降低VEGF、EMAb水平，改善性激素水平有关。

Abstract:

[Objective] Study on the preventive effect and mechanism of Bushen Huayu Formula on postoperative recurrence of endometriosis with kidney deficiency and blood stasis. [Methods] A total of 320 patients with endometriosis were selected for hospital treatment and enrolled from January 2019 to January 2021 in the Fourth People's Hospital of Hengshui. The patients were divided by random number table method. 160 patients were in the conventional Western medicine group and received conventional Western medicine treatment,and 160 patients were in the Busheng Huayu Formula group,which received addition and subtraction treatment of Busheng Huayu Formula in addition to conventional Western medicine treatment. Serum sex hormones:luteinizing hormone (LH), progesterone(P) and estrogen(E₂) were detected in 2 groups before and after treatment. The levels of tumor necrosis faction-A(TNF-a), vascular endothelial growth factor (VEGF),and anti-endometrial antibody (EMAb) were evaluated by verbal description score(VRS). The symptoms of dysmenorrhea and non-menstrual pelvic pain were evaluated. The clinical efficacy of the conventional Western medicine group and the Bushen Huayu Formula group were compared,and the 2-year recurrence rate of the two groups was recorded. The occurrence of adverse reactions in the two groups during treatment was recorded. [Results] The scores of dysmenorrhea and nonmenstrual pelvic pain in Bushen Huayu Formula group were lower than those in conventional Western medicine group (P<0.05). The levels of TNF-α,VEGF and EMAb in Bushen Huayu Formula group were lower than those in conventional Western medicine group (P< 0.05),the contents of LH,P and E₂ in Bushen Huayu Formula group were significantly lower than those in conventional Western medicine group(P<0.05). The traditional Chinese medicine syndrome score of Bushen Huayu Formula group was significantly lower than that of conventional Western medicine group(P<0.05),the total effective rate of Bushen Huayu Formula group(97.50%) was higher than that of conventional Western medicine group(88.13%)(P<0.05),the 2-year recurrence rate of conventional Western medicine group was 12.90%,and that of Bushen Huayu Formula group was 3.21%. The recurrence rate of 2 years between the two groups was statistically significant (P<0.05). The onset time of recurrence in the Bushen Huayu Formula group was longer than that in the conventional Western medicine group(P<0.05),and no obvious adverse reactions occurred in the two groups during treatment. [Conclusion] The addition and reduction of Bushenhuayu Formula in the treatment of endometriosis with kidney deficiency and blood stasis has significant postoperative effect,which can effectively relieve dysmenorrhea and non-menstrual pelvic pain in patients and reduce the recurrence rate. Its mechanism of action may be related to its inhibition of body inflammation,reduction of VEGF and EMAb levels,and improvement of sex hormone indexes.