健膜汤联合屈螺酮炔雌醇片治...活剂抑制因子-1水平的影响_宫月.pdf

世界中西医结合杂志 2023 年第 18 卷第 1 期World Journal of Integrated Traditional and Western Medicine2023，Vol.18，No.1临床研究DOI:10 13935/j cnki sjzx 230118基金项目:河北省 2016 年度医学科学研究重点课题(20160290);承德市科学技术研究与发展计划项目(202109A012)作者单位:河北省承德市妇幼保健院，河北 承德 067000通信作者:刘军，Email:qurei32163 com健膜汤联合屈螺酮炔雌醇片治疗子宫内膜息肉患者的疗效及对转化生长因子 1、纤溶酶原激活剂抑制因子 1 水平的影响宫月邴伯东刘军刘洋【摘要】目的探讨健膜汤联合屈螺酮炔雌醇片治疗子宫内膜息肉患者的疗效及对转化生长因子 1(Transforming growth factor ，TGF 1)、纤溶酶原激活剂抑制因子 1(ecombinant Plasminogen Activator Inhibi-tor 1，PAI 1)水平的影响。方法选取2020 年1 月2022 年1 月期间河北省承德市妇幼保健院收治的子宫内膜息肉患者 100 例，采用随机数字表法分为观察组 50 例和对照组 50 例。对照组给予屈螺酮炔雌醇片治疗，在对照组基础上观察组加用健膜汤治疗。治疗 3 个月经周期后，观察比较两组患者临床疗效，治疗前后中医证候积分，子宫内膜息肉长、短径线长度，内膜厚度，血清 TGF 1、PAI 1 水平及不良反应发生率。结果治疗后观察组治疗总有效率 94 00%(47/50)与对照组 78 00%(39/50)比较，差异有统计学意义(P 0 05)。治疗 1、3 个月经周期后两组患者中医证候积分均较治疗前明显降低，差异有统计学意义(P 0 05);且观察组降低程度较对照组明显，差异有统计学意义(P 0 05)。治疗 3 个月经周期后两组患者子宫内膜息肉长、短径及内膜厚度均较治疗前缩小，差异有统计学意义(P 0 05);且观察组缩小程度明显优于对照组，差异有统计学意义(P 0 05)。治疗 3个月经周期后两组患者血清 TGF 1、PAI 1 水平均较治疗前降低，差异有统计学意义(P 0 05);且观察组降低程度明显优于对照组，差异有统计学意义(P 0 05)。治疗期间，两组患者不良反应发生率比较，差异无统计学意义(P 0 05)。结论健膜汤联合屈螺酮炔雌醇片治疗子宫内膜息肉，能有效改善患者临床症状，抑制内膜增生，缩小内膜息肉，降低血清 TGF 1、PAI 1 水平。【关键词】健膜汤;屈螺酮炔雌醇片;子宫内膜息肉;转化生长因子 1;纤溶酶原激活剂抑制因子 1【中图分类号】711【文献标识码】ATherapeutic Effect of Jianmo Decoction Combined with Drospirenone and EthinylEstradiol Tablets on Endometrial Polyps and Its Effects on TGF 1 and PAI 1Levels in PatientsGONG Yue，BING Bo dong，LIU Jun，LIU Yang(Chengde Maternal and Child Health Hospital，Chengde Hebei 067000)【Abstract】ObjectiveTo explore the therapeutic effect of Jianmo Decoction combined with drospirenone and eth-inyl estradiol tablets on endometrial polyps and its influence on the levels of transforming growth factor 1(TGF 1)and plasminogen activator inhibitor 1(PAI 1)in patients MethodsA total of 100 patients with endometrial polyps ad-mitted to Chengde Maternal and Child Health Hospital from January 2020 to January 2022 were enrolled and randomly di-vided into an observation group(n=50)and a control group(n=50)according to the random number table method All pa-tients were treated with drospirenone and ethinyl estradiol tablets，while those in the observation group received additionalJianmo Decoction After treatment for three menstrual cycles，clinical efficacy，traditional Chinese medicine(TCM)syn-drome score before and after treatment，long and short diameters of endometrial polyps，endometrial thickness，serum TGF 1 and PAI 1 levels，and incidence of adverse reactions were observed and compared between the two groups esultsAfter treatment，the total effective rate of the observation group was 94 00%(47/50)，higher than 78 00%(39/50)of thecontrol group(P 0 05)After treatment for one menstrual cycle and three menstrual cycles，the TCM syndrome scores ofthe two groups decreased obviously(P 0 05)，and the reduction degree of the observation group was superior to that of411世界中西医结合杂志 2023 年第 18 卷第 1 期World Journal of Integrated Traditional and Western Medicine2023，Vol.18，No.1the control group(P 0 05)After treatment for three menstrual cycles，the short and long diameters and endometrialthickness of endometrial polyps in the two groups decreased(P 0 05)，and the reduction degree of the observation groupwas superior to that of the control group(P 0 05)After treatment for three menstrual cycles，the levels of serum TGF 1 and PAI 1 in both groups decreased(P 0 05)，and the reduction degree of the observation group was superior tothat of the control group(P 0 05)There was no significant difference in the incidence of adverse reactions between theobservation group and the control group(P 0 05)ConclusionIn the treatment of endometrial polyps，Jianmo Decoc-tion combined with drospirenone and ethinyl estradiol tablets can improve the clinical symptoms of patients，effectively in-hibit endometrial hyperplasia，reduce endometrial polyps，and reduce the levels of serum TGF 1 and PAI 1【Keywords】Jianmo Decoction;Drospirenone and Ethinyl Estradiol Tablets;Endometrial Polyps;TransformingGrowth Factor 1;Plasminogen Activator Inhibitor 1子宫内膜息肉好发于 35 岁以上妇女，是子宫局部内膜过度增生所致。该病以经期时间长、月经量多、经间期出血、不孕等为主要临床症状，其发病原因尚无确切定论，可能与遗传、雌孕激素分泌异常、炎症刺激、细胞因子、细胞增殖/凋亡失衡、药物等因素有关1，2。现代医学通常采用手术切除的手段治疗子宫内膜息肉，并在术后给予孕激素、避孕药、左炔诺孕酮宫内缓释系统以预防复发。但手术容易损伤子宫内膜，且术后复发率高，越来越多患者更趋向于药物保守治疗。中医学并无子宫内膜息肉相关病名记载，根据其临床症状多归属于“崩漏”“月经过多”“癥瘕”等范畴，病因病机多与血瘀有关，治疗注重活血化瘀。健膜汤具有祛瘀止痛，活血散结之功，现代医学表明祛瘀活血类方药能改善子宫血流供应，提高子宫内膜容受性3，符合子宫内膜息肉的治证，本研究观察其疗效及治疗前后患者血清转化生长因子 1(Transforming growth fac-tor ，TGF 1)、纤溶酶原激活剂抑制因子 1(ecombinant Plasminogen Activator Inhibitor 1，PAI1)水平的变化，现报道如下。1资料与方法1 1临床资料1 1 1一般资料选取 2020 年 1 月2022 年 1 月期间我院收治子宫内膜息肉患者 100 例，采用随机数字表法分为两组:观察组 50 例和对照组 50 例。对照组患者年龄 20 44 岁，平均(33 8 4 2)岁;病程 7 11 个月，平均(7 48 3 16)个月;有孕病史 6 例，无孕病史 44 例;有宫腔镜手术史 40 例，无宫腔镜手术史10 例;子宫息肉单发 32 例，多发 18 例;息肉直径0 2 5 4 cm，平均(1 72 0 94)cm。观察组患者年龄21 45 岁，平均(34 2 4 6)岁;病程8 12 个月，平均(7 63 3 08)个月;有孕病史 8 例，无孕病史 42 例;有宫腔镜手术史 38 例，无宫腔镜手术史12 例;子宫息肉单发 30 例，多发 20 例;息肉直径0 2 5 3 cm，平均(1 75 0 92)cm。两组患者一般资料比较，差异无统计学意义(P 0 05)，具有可比性。本研究经本院医学伦理委员会审核批准(审批号:2019 CY 03)。1 1 2诊断标准1 1 2 1西医诊断标准参照妇产科学4 制定子宫息肉西医诊断标准。1 1 2 2中医诊断标准参照 中医妇产科学5 中药新药临床