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扶正化瘀剂结合艾灸法对内异症盆腔痛的临床观察及对肿瘤坏死因子-α的影响
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摘要
目的:通过观察扶正化瘀剂结合艾灸法治疗45例肾虚血瘀型内异症盆腔痛患者的临床疗效,比较治疗前后内异症患者盆腔痛、体征、肿瘤坏死因子-α(TNF-α)、CA125、B超等的变化情况,评价扶正化瘀剂结合艾灸法治疗盆腔内异症的临床疗效,观察其对TNF-α的影响,并探讨中药结合艾灸法对内异症的作用机制,为内异症的中医治疗开创新的治疗途径。
     方法:通过收集我院门诊就诊并符合纳入标准的肾虚血瘀型子宫内膜异位症病例45例,随机分为3组。治疗组15例采用中药扶正化瘀剂结合艾灸法治疗,对照组A组15例采用中药扶正化瘀剂加减治疗,对照组B组15例采用艾灸在经前及经期治疗。比较治疗前后相关症状、体征及血清TNF-α、血清CA125、B超等的变化情况。
     结果:治疗组治疗前、后疼痛评分、NRS评分、中医症状、体征评分为(12.57+2.17)、(5.87±1.6)、(17.07+5.55)、(6.07+2.4)和(6.10+0.28)、(1.77+0.60)、(3.87±2.33)、(3.27±1.35);对照组A治疗前后疼痛评分、NRS评分、中医症状、体征评分为(11.77+1.27)、(5.53±1.06)、(15.47+2.77)、(5.8+1.15)和(6.90+0.55)、(2.33±0.49)、(7.47±2.56)、(3.53±0.92);对照组B治疗前后疼痛评分、NRS评分、中医症状、体征评分为(11.60±1.03)、(5.27±0.88)、(14.13+2.67)、(5.13±1.30)和(7.3±0.75)、(2.80±0.68)、(9.47±2.45)、(4.53±0.99)。治疗组与对照组的疼痛评分、NRS评分、中医症状评分比较,P值均<0.05。三组体征比较,治疗组与对照组B间P<0.05;治疗组与对照组A间P>0.05,对照组A组与对照组B组之间P<0.05。治疗后三组TNF-α水平总体均较治疗前有所下降,CA,25水平总体均较治疗前有所下降。治疗组显效9例,显效率为64%,总有效率为86%;对照组A组显效6例,有效4例,总有效率为71%;对照组B组显效2例,有效7例,总有效率为67%。
     结论:通过扶正化瘀剂加减结合艾灸法治疗内异症盆腔痛,能够达到缓解疼痛、改善症状、体征的疗效,其疗效治疗组明显优于单纯中药治疗或单纯艾灸治疗的对照组。三组治疗后CA125水平均有所下降,其中,治疗组明显优于对照组。三组治疗后血清TNF-α水平均较治疗前明显下降,其下降疗效,治疗组优于对照组;三组均可通过降低血清TNF-α水平的表达,从而达到缓解疼痛的作用。
Purpose:Comparing the changes of pelvic pain、signs、Tumor necrosis factor-a (TNF-α)、CA125、B-Ultrasonic in endometriosis patients before and after treatment, by observing clinical efficacy of Fuzhenghuayu method combined with Moxibustion treatment in 45 cases with kidney deficiency and blood stasis type of pelvic pain of endometriosis. Evaluation clinical efficacy of the method treatment pelvic endometriosis, observe the effects of TNF-a, and to explore mechanism of the method. Open up new therapeutic approaches to Chinese medicine for the treatment of endometriosis.
     Method:By collecting 45 cases which were treated in our hospital and met the inclusion criteria of the kidney deficiency and blood stasis type of pelvic pain of endometriosis, randomly divided this cases into 3 groups:treatment group of 15 patients treated with Fuzhenghuayu method combined with Moxibustion; control group A group included 15 patients with Fuzhenghuayu method; control group B group contained 15 patients with moxibustion before and in the menstrual period. To compare the changes of related symptoms、signs、TNF-α、CA125、B-Ultrasonic and etc before and after treatment.
     Result:Before and after treatment, pain score. NRS score, clinical symptoms and signs scores were followed respectively:treatment group(12.57±2.17)、(5.87±1.6)、(17.07±5.55)、(6.07±2.4) and (6.10±0.28)、(1.77±0.60)、(3.87±2.33)、(3.27±1.35); control group A group(11.77±1.27)、(5.53±1.06)、(15.47±2.77)、(5.8±1.15) and (6.90±0.55)、(2.33±0.49)、(7.47±2.56)、(3.53±0.92); control group B group(11.60±1.03)、(5.27±0.88)、(14.13±2.67)、(5.13±1.30) and (7.3±0.75)、(2.80±0.68)、(9.47±2.45)、(4.53±0.99). Compared treatment group and control group pain scores, NRS score, clinical symptoms scores, all P<0.05; compared three groups of signs, treatment group and control group B group P<0.05, but treatment group and control group A, or control group A and B, P>0.05. After treatment, the overall level of CA125 and TNF-αwas less than its than before treatment. Treatment group have 9 cases in markedly, its effective rate was 64%, and the total effective rate was 86%; control group A group have 6 cases in markedly,5 cases in effective,and the total effective rate was 71%; control group B group have 2 cases in markedly,7 cases in effective,and the total effective rate was 60%.
     Conclusion:Fuzhenghuayu method combined with Moxibustion treatmenting pelvic pain of endometriosis can achieve the effect of relieving pain and improving the symptoms and signs, The therapeutic effect of treatment group is better than control group with only a simple method. After treatment, the overall level of CA125 in three groups were decreased, the effect in treatment group is obviously better than control group; the level of TNF-a in three groups significantly were decreased, the effect in treatment group is better than control group. All three groups can be by reducing the level of TNF-a expression, so as to achieve the effect of pain relief.
引文
[1]郎景和.关于子宫内膜异位症的再认识及其意义[J].中国工程科学,2009,11(10):137—142.
    [2]张喜,林俊.核转录因子与子宫内膜异位症发病机制[J].国际妇产科学杂志,2008,35(4):265-267.
    [3]杨鉴冰,杜艳玲.祛异康对子宫内膜异位症大鼠血液流变学的影响[J].现代中医药,2009,29(1):16-17.
    [4]李淑萍,白淑芳.妇痛宁联合免疫法对子宫内膜异位症免疫功能的影响[J].辽宁中医学院学报,2005,7(5):442-443.
    [5]杨东霞,马文光,马宝璋,等.异位宁对实验性子宫内膜异位症大鼠的治疗作用[J].山东中医杂志,2006,25(4):262-264.
    [6]具春花,金钟大,司徒仪.补肾活血方对内异症合并LUFS患者EMAB、CA125、PRL的影响[J].江苏中医药,2007,39(9):22-24.
    [7]曹立幸,韩冰,李同玺,等.活血化瘀、软坚散结法对子宫内膜异位症IL一6影响[J].河南中医学院学报,2007,22(6):19-20.
    [8]王本祥.现代中药药理学[M].天津科学技术出版社,1997:877-879.
    [9]王如英,周琳.活血化瘀法治疗子宫内膜异位症的临床观察[J].中国中西医结合杂志,2004,24(3):258-259.
    [10]司徒仪,樊荫萍,潘华新.莪棱胶囊对大鼠实验性子宫内膜异位症作用机理探讨[J],中医杂志,2000,41(4):237.
    [11]李祥云.补肾祛瘀法治疗子宫内膜异位症[J].中国临床医生,2003,31(8):50-52.
    [12]付金荣,董肇杨.血管加压素与子宫内膜异位症疼痛的关系及中药对其的影响[J].上海中医药杂志,2000;23(10):10-11.
    [13]黄艳辉,司徒仪.司徒仪治疗子宫内膜异位症经验[J].辽宁中医杂志,2006,33(1):16-17.
    [14]刘艳巧,刘润侠.中药内异消对子宫内膜异位症大鼠腹腔液TNF-α影响[J].贵阳中医学院学报,2004;26(1):58-60.
    [15]刘艳巧,刘润侠.补肾活血方对大鼠子宫内膜异位症血管生长因子等影响的研究[J].湖南中医学院学报,2004;24(1):16-18.
    [16]夏桂成.用基础体温观察补阳消症汤治疗于宫内膜异位性不孕症33例[J].新中医,1994,26(1):41-42.
    [17]范红霞,王霞灵,叶燕萍.益气活血方药内服与灌肠治疗子宫内膜异位症临床研究[J].中国中医急症,2007,16(9):1078-1079.
    [18]李巧芬,赵志梅.中医综合疗法治疗子宫内膜异位症[J].中国临床医生,2008,36(8):43-45.
    [19]付于,夏天.针药并用治疗子宫内膜异位症的临床观察[J].上海针灸杂志,2005,24(3):3-5.
    [20]沈姚琴,陆金霞,陆文彬.自拟化异定痛饮结合穴位注射治疗子宫内膜异位症68例[J].中医药临床杂志,2007,19(3):233.
    [21]向东方,梁雪芳,司徒仪.中医多途径疗法治疗子宫内膜异位症痛经51例分析[J].中医药学刊,2005,23(9):1616-1617.
    [22]刘艳霞,李秀荣.中医综合治疗子宫内膜异位症31例疗效观察[J].临床和实验医学杂志,2006,5(1):61.
    [23]王连容,粱炳垣,粱雪梅.中西医结合治疗子宫内膜异位症 42 例[J].中国中医药科技,2006,13(3):195.
    [24]邵顺芳.中西医结合治疗子宫内膜异位症80例[J].现代中西医结合杂志,2008,17(14):2168-2169.
    [25]钟蓝.传统艾灸作用机理初探[J].中国中医基础医学杂志,1999,5(6):46.
    [26]杨华元,刘堂义.艾灸疗法的生物物理机制初探[J].中国针灸,1996,16(10):17.
    [27]洪文学,樊凤杰,宋佳霖.传统艾灸治疗肿瘤的免疫学机理研究与展望[J].北京生物医学工程,2007,26(3):327-329.
    [28]谭琳蓥,刘慧荣,吴焕淦,等.艾灸疗法活血化瘀作用研究进展[J].中华中医药学刊.2009,27(2):272-274.
    [29]杨星丽.艾灸配合中药治疗原发性痛经30例[J].中国中医急症,2009,18(7):1165.
    [30]汪慧敏,陈华德.子宫内膜异位症的针灸治疗临床研究[J].针刺研究.2000,25(2):148-150.
    [31]汤萍.艾灸治疗原发性痛经34例的临床分析[J].井冈山学院学报(自然科学).2008,29(8):109.
    [32]张君娜,陈素琴,周娜静,等AHSG和IL-6基因多态性与IV期卵巢子宫内膜异位囊肿的相关性研究[J].现代妇产科进展,2006,15:346-349.
    [33]冷金花,等.第一届全国内异症会议纪要[J].中华妇产科杂志,2001,36(1):714-716.
    [34]赵雨花,张菊红,马云宝,等.EMS患者血清、腹腔液TGF-β、IGF-I、TNF-a及IL-8水平测定[J].放射免疫学杂,2006,19(6):457-459.
    [35]郎景和.子宫内膜异位症的基础与临床研究(第一卷)[M].北京:中国协和医科大学出版社,2003,6:105,249-255
    [36]陆品红,刘嘉茵.肿瘤坏死因子与子宫内膜异位症[J].国外医学妇产科学分册,2004 (3):173-176.
    [37]郭永红,等.丹赤饮对子宫内膜异位症患者血清CA125和肿瘤坏死因子及性激素水平的影响[J].中华中医药杂志,2007,12(22):892-894.
    [38]曹泽毅.中华妇产科学(第二版)[M].北京:人民卫生出版社,2005:1481-1493.
    [39]张欣,吴令英,李小江,等.盆腔良性肿瘤伴血清CA125水平升高的临床意义[J].中华妇产科杂志,2005,40(3):178-182.
    [40]子宫内膜异位症专题[J].中国实用妇科与产科杂志,2002,18(3):139.
    [41]张玉蓉,徐莉,谢波.补肾活血法对子宫内膜异位症不孕患者EMAB、CA125的影响[J].中国医药学报, 2004,19(5):319-320.
    [42]Sillem M,Prifti S,MongeB,et al.Intergrin-mediated adhesion of uterine endometrial cell from endometriosis patients to extracellular matrix proteins is enhanced by tumor necrosis factor alpha and interleukin-1.Eur J Obstet Gynnecol Reprod Biol,1999,87 (2):123-7.
    [43]Fujimoto J,Ichigo S,et al. Expression of E-cadherin,α-and β-catenin mRNA in ovarian endometriosis. Eur J Obstet Gynnecol Reprod Biol,1996,67:179-183.
    [44]刘润侠,刘艳巧.补肾活血方对子宫内膜异位症不孕患者子宫内膜的影响[J].中国中医药信息杂志,2005,12(6):14-15.
    [45]黄英,吴婷,谭万信.化瘀止痛片对模型大鼠异位子宫内膜细胞因子影响的研究[J].中华中医药杂志,2005,20(11):655-658.
    [46]刘学军.基质金属蛋白酶及其抑制剂在子宫内膜异位症中的作用[J].现代妇产科进展,2001,10(5):376-378.
    [47]邓玉清,白骏,徐望明.子宫内膜异位症患者血管内皮生长因子的测定[J].中西医结合杂志,2004,13(14):1827-1828.
    [48]吴献群,李海棠,黄虹.加味散结镇痛方对实验性子宫内膜异位症大鼠血管内皮生长因子的影响[J].湖北中医杂志,2005,27(11):3-5.
    [49]周应芳.子宫内膜异位症的临床诊断与治疗[J].中华妇产科杂志,2005,40:67-70.
    [50]Frishman G N, Salak J R. Conservative surgical management ofendometriosis in women with pelvic pain[J].J minim invasive Gynecol,2006,13(6):546-558.
    [51]裘琳,张信美.芳香化酶与子宫内膜异位症相关研究进展[J].国际妇产科学杂志,2008,35(4):259-262.
    [52]蒋红清.子宫内膜异位症药物及生物治疗新进展[J].现代妇产科进展,2006,15(2):134-137.
    [53]郎景和.子宫内膜异位症基础与临床研究的几个问题[J].中国实用妇科与产科杂志,2002,18(3):129-130.
    [54]李晓燕,冷金花.子宫内膜异位症疼痛研究进展和治疗策略[J].国际妇产科学杂志.2009,36(3):225-227.
    [55]冷金花.子宫内膜异位症疼痛的研究现状及方向[J].中华妇产科杂志,2009,44(5):321-323.
    [56]李央,林金芳.子宫内膜异位症发病机理研究进展[J].中华妇产科杂志,2005,40(1):55-57.
    [57]张宝文,弓瑞飞,于敏.补肾祛瘀汤对子宫内膜异位症大鼠IL-12 P40和VEGF的影响[J].中国中医药科技,2010,17(2):104-105.
    [58]韦丛丽.补肾活血化瘀法对子宫内膜异位症患者临床疗效及肿瘤坏死因子的影响[J].光明中医,2011,2(2):261-262.
    [59]陈云华,龚慕辛,卢旭然,等.鬼箭羽及同属植物主要药理作用及有效成分研究进展[J].北京中医药,2010,2(2):143-144.
    [60]Chung TW, Moon SK, Chang YC, et al. Novel and therapeuticeffect of caffeic acid and caffeic acid phenethyl esteron hepatocarcinoma cells:complete regression of hepatomagrowth and metastasis by dual mechanism [J].FASEB Journal,2004,18 (14):1670-1681.
    [61]李竹,晏媛,李青.杜仲的药理活性研究进展[J].中国药事,2004,18(2):131-132.
    [62]王一涛,王家葵,杨奎,等.续断的药理学研究[J].中药药理与临床,1996,12(3):20-23.
    [63]何国萍.续断的药理作用与临床应用[J].中国药物滥用防治杂志,2010,16(2):120-121.
    [64]王庭欣,赵文,蒋东升.G海带多糖对小鼠免疫功能的调节作用[J].卫生毒理学杂志,2000,14(2) : 75.
    [65]王庭欣,蒋东升,马晓彤.等.海带多糖对小鼠H22实体瘤的抑制作用[J].卫生毒理学杂志2000,14(4):242.
    [66]曹利娟,刘华钢,刘丽敏等.莪术油近五年的研究进展[J].医学综述,2010,2(3):447-449.
    [67]焦红军.党参的药理作用及其临床应用[J].临床医学,2005,4(4):92-93.
    [68]张敏,高晓红,孙晓萌,等.茯苓的药理作用及研究进展.[J].北华大学学报(自然科学版),2008,9(1):63-67.
    [69]马丽.穿山甲的药理及临床研究[J].中医药研究,2002,18(2):46-47.
    [70]孙新建,李志浩.白毛夏枯草的研究进展[J].中医药导报,2010,16(3):102-104.
    [71]夏泉,张平,李绍平等.当归的药理作用研究进展[J].时珍国医国药,2004,15(3):164-165.
    [72]刘家兰,徐晓玉.山楂的药理作用研究进展[J].中草药.2009,40:63-65.
    [73]时燕萍,傅有丰等.内异停对离体培养的子宫内膜异位症的异位子宫内膜细胞的直接抑制作用[J].实用中医药学刊,2005,23(5):896—898.
    [74]杨桂云,刘红林.补肾活血方对子宫内膜异位症不孕腹腔液微环境改善作用的实验研究[J].中医药学刊,2003,21(1):57—59.
    [75]刘金星,秦元军,张家英.化瘀消癓软坚散结法治疗家兔实验性子宫内膜异位症的研究[J].山东中医药大学学报,1998,22(3):227.
    [76]李云霞,徐琳,苏玉林.血清和腹腔液中IL-6、TNF-α及CA125与子宫内膜异位症关系探讨[J].昆明医学院学报,2009,30(9):73-78.
    [77]McBean JH,Brumsterd JR.In vitro CA125 secretion by endometrium from women with advanced enometriosis[J].Fertil Steril,1993,59(1):89.

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